American Public Health Association, Atlanta, GA, October
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
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).
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.
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.