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Effectiveness Of Peer Workers In A Treatment Program For Latent TB Infection
2001 International Conference of the American Thoracic Society, San Francisco, CA. May 2001.

El-Sadr W, Hirsch-Moverman Y, Colson P, Thomas G, Nader N, Gee V, Findley S, Medard F. Effectiveness Of Peer Workers In A Treatment Program For Latent TB Infection.

Rationale: Treatment (tx) for latent tuberculosis infection (LTBI) has become a high priority in TB control. However, adherence rates to self-administered LTBI tx have been low. Support from peer workers in LTBI tx may represent a modality which improves completion rates, with lower costs than directly observed preventive tx.

Methods: In a randomized clinical trial, 231patients (pts) undergoing treatment for LTBI were assigned to a peer worker (PW) or self-administered treatment. PWs were members of the same community, who have successfully completed TB treatment. Most HIV- pts received 6 mos tx. Definition of on-time tx followed CDC guidelines (e.g., 6 mo tx within 9 mos for HIV- pts). Information was collected on pts' social support, service use, TB knowledge and attitudes, and substance use.

Results: Pts were 56% male, 70% African-American and 22% Latino. Median age was 34, 47% were foreign-born, 50% completed high school, and 27% were married. Controls were more likely to have been homeless (p=.003). Differences in other demographic variables were not significant. 79% of exp pts completed LTBI tx, compared to 62% of controls (p=.009). Of those who completed, 89% of exp pts completed on time, compared to 91% of controls (p=.787). Of those who were never homeless, 82% of exp pts and 62% of controls completed (p=.014). Of homeless pts, 71% of exp and 62% of controls completed (p=.470).

Conclusions: This preliminary analysis suggests that PWs can make a vital contribution to completion of LTBI tx. Homeless pts may need extra supports to ensure tx completion. Further analyses will control for the impact of personal characteristics on tx completion.