American Public Health Association, Atlanta, GA, October
Thomas G, Colson P, Gee V, Hirsch-Moverman
Y, Findley S, El-Sadr W. Peer Workers For Adherence
To Treatment For Latent Tuberculosis Infection: The Program
Recent TB control efforts in the U.S. emphasize treatment
for Latent Tuberculosis Infection (LTBI). Adherence to LTBI
treatment has been poor because patients do not perceive themselves
as sick. One service model uses peer workers (PW) who have
been treated for TB.
In a randomized clinical trial, LTBI patients were
assigned to a PW or self-administered treatment. PWs complete
contact forms for each encounter and assessments of each patient
who finishes treatment. Data on 57 patients who were assigned
a PW and completed LTBI treatment were analyzed. Length of
LTBI treatment varied from 6-12 months, averaging 13 encounters
per patient. Encounters most often occurred in the clinic
(36%), 17% in PWs' office, and 15% in patients' homes. Actions
included counseling (82%) (adherence, personal matters, medical
issues, medications), navigation (8%), checking-up on patients
(8%), and referrals (4%). As per PW assessments, 14% of patients
adhered every day with LTBI, 81% most days, and 5% were non-adherent.
Reasons for non-adherence included having too many other problems
(50%), not understanding regimen (21%), side effects (17%),
not thinking they were sick (15%), and homelessness (10%).
PWs thought that 63% of patients benefited from their relationship,
25% did not need a PW, they were unable to communicate with
11%, and 2% of patients became too dependent.
use of PWs who themselves completed TB treatment may provide
feasible and cost-effective models for helping patients adhere
to LTBI treatment. Such models are particularly relevant in
under-served communities with poor health outcomes.