American Public Health Association, Atlanta, GA, October 2001

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 Manager's Perspective

Issues: 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.

Description: 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.

Conclusion: The 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.