American Public Health Association, Atlanta, GA, October 2001

Gee V, Thomas G, Hirsch-Moverman Y, Colson P, Findley S, El-Sadr W. Peer Workers for Adherence to Treatment for Latent Tuberculosis Infection: The Peer Worker Perspective

Issues: Peer workers (PWs) have been used in developing countries to monitor patients in treatment for TB disease. In the U.S., they may play a role in enhancing adherence to treatment for latent TB infection (LTBI).

Description: A PW program was established to provide social support and assistance to persons on LTBI treatment in Harlem. PWs are members of the same community, who have successfully completed TB treatment. They often use personal experience to convince patients to initiate treatment or to remain adherent. Many patients do not value LTBI treatment as they do not perceive themselves as sick. Some shun treatment because of misconceptions about BCG vaccination or side effects. Others struggle with conditions which interfere with adherence and are common in our community -- substance use, homelessness, poverty, child care or other demands. Forming a relationship with LTBI patients is often difficult. PWs use their personal experience to help patients obtain needed services in the hospital and in the community. Most patients appear to benefit from the PWs' assistance. When treatment is completed after 6 - 12 months, some are reluctant to sever their relationship with the PW. The challenge for the PW is to present treatment completion positively, emphasizing skills the patient has acquired while being adherent and meeting daily needs.

Conclusion: PW programs represent an important means of assisting hard to reach patients. PWs also serve as role models, providing examples of individuals who have overcome adversity and are now helping others to do the same.