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J Urban Health. 1999 Dec; 76(4): 461–467.
PMCID: PMC3456694

Incentives and accessibility: A pilot study to promote adherence to TB prophylaxis in a high-risk community



A community-based directly observed preventive therapy (DOPT) program for treatment of latent tuberculosis infection among injection drug users (IDUs) in an innercity neighborhood.


To test adherence to a 6-month course of DOPT using cash incentives and an easily accessible neighborhood location.


Street-recruited IDUs (N=205) were screened forMycobacterium tuberculosis (TB) infection using the Mantoux test and two controls. Subjects who had a purified protein derivative (PPD) reaction of ≥5 mm, were anergic, or had a history of a positive PPD received clinical evaluation at a community field site, provided in collaboration with the San Francisco Department of Public Health Tuberculosis Clinic. Twenty-eight subjects were considered appropriate candidates for prophylaxis with isoniazid, and 27 enrolled in the pilot study. Participants received twice-weekly DOPT at a community satellite office, with a $10 cash incentive at each visit.


The 6-month (26-week) regimen was completed by 24/27 (89%) participants. The median time to treatment completion was 27 weeks (range 26 to 34 weeks). The median proportion of dosing days attended in 6 months was 96%.


Community-based DOPT using cash incentives resulted in high levels of adherence and treatment completion among drug users.

Key Words: Adherence, Incentives, Tuberculosis, Injection Drug Users, Directly Observed Preventive Therapy

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Selected References

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1. Centers for Disease Control and Prevention Prevention and control of tuberculosis in US communities with at-risk minorities; and among homeless persons: recommendations of the Advisory Council for the Elimination of Tuberculosis. Morb Mortal Wkly Rep. 1992;41(RR5):1–23. [PubMed]
2. Centers for Disease Control and Prevention The use of preventive therapy for tuberculosis infection in the United States: recommendations of the Advisory Committee for the Elimination of Tuberculosis. Morb Mortal Wkly Rep. 1990;39(RR-8):9–12. [PubMed]
3. Gourevitch MN, Alcabes P, Wasserman WC, Arno PS. Cost-effectiveness of directly observed chemoprophylaxis of tuberculosis among drug users at high risk for tuberculosis. Int J Tuberc Lung Dis. 1998;2(7):531–540. [PubMed]
4. Daly CL, Hahn HA, Moss AR, Hopewell PC, Schecter GF. Incidence of tuberculosis in injection drug users in San Francisco: impact of anergy. Am J Respir Crit Care Med. 1998;157:19–22. [PubMed]
5. Snyder DC, Paz EA, Mohle-Boetani J, Black R, Fallstad R, Chin DP. Tuberculosis prevention in methadone maintenance clinics: effectiveness and cost-effectiveness. Am J Respir Crit Care Med. 1999;160:178–185. [PubMed]
6. Smirnoff M, Goldberg R, Indyk L, Adler JJ. Directly observed therapy in an inner city hospital. Int J Tuberc Lung Dis. 1998;2(2):134–139. [PubMed]
7. Giuffrida A, Torgerson D. Should we pay the patient? Review of financial incentives to enhance patient compliance. BMJ. 1997;315:703–707. [PMC free article] [PubMed]
8. Volmink J, Garner P. Systematic review of randomised controlled trials of strategies to promote adherence to tuberculosis treatment. BMJ. 1997;315:1403–1406. [PMC free article] [PubMed]
9. Malotte CK, Rhodes F, Mais K. Tuberculosis screening and compliance with return for skin test reading among active drug users. Am J Public Health. 1998;88:792–796. [PMC free article] [PubMed]
10. Pilote L, Tulsky J, Zolopa A, Hahn J, Schecter G, Moss A. Tuberculosis prophylaxis in the homeless: a trial to improve adherence to referral. Arch Intern Med. 1996;156:161–165. doi: 10.1001/archinte.156.2.161. [PubMed] [Cross Ref]
11. Malotte CK, Hollingshead JR, Rhodes F. Monetary versus nonmonetary incentives for TB skin test reading among drug users. Am J Prev Med. 1999;16(3):182–188. doi: 10.1016/S0749-3797(98)00093-2. [PubMed] [Cross Ref]
12. Watters JK. Trends in risk behavior and HIV seroprevalence among injecting drug users in San Francisco, 1986–1992. J Acquir Immune Defic Syndr. 1994;7:1276–1281. [PubMed]
13. Watters JK, Biernacki P. Targeted sampling: options for the study of hidden populations. Soc Problems. 1989;36:416–430.
14. Lifson AR, Grant SM, Lorvick J, et al. Two-step tuberculin skin testing of injection drug users recruited from community-based settings. Int J Tuberc Lung Dis. 1997;1:128–134. [PubMed]
15. Lifson AR, Thompson S, Grant S, Hilk R, Lorvick J. Skin test anergy among injection drug users recruited from community settings. J Drug Issues. 1998;28(4):891–904.
16. Centers for Disease Control Purified protein derivative (PPD)-tuberculin anergy and HIV infection: guidelines for anergy testing and management of anergic persons at risk of tuberculosis. Morb Mortal Wkly Rep. 1991;40(RR-5):27–33. [PubMed]
17. Fitzgerald JM, Patrick DM, Strathdee S, et al. Use of incentives to increase compliance for TB screening in a population of intravenous drug users. Vancouver Injection Drug Use Study Group. Int J Tuberc Lung Dis. 1999;3:153–155. [PubMed]
18. Farmer P, Robin S, Ramilus S, Kim JY. Tuberculosis, poverty, and “compliance”: lessons from rural Haiti. Semin Respir Infect. 1991;6(4):254–260. [PubMed]
19. Chaulk CP, Moore-Rice K, Rizzo R, Chaisson RE. Eleven years of community-based directly observed therapy for tuberculosis. JAMA. 1995;274:945–951. doi: 10.1001/jama.274.12.945. [PubMed] [Cross Ref]
20. Nazar-Stewart V, Nolan CM. Results of a directly observed intermittent isoniazid preventive therapy program in a shelter for homeless men. Am Rev Respir Dis. 1992;146:57–60. [PubMed]
21. Alcabes P, Vossenas P, Cohen R, et al. Compliance with isoniazid in jail. Am Rev Respir Dis. 1989;140:1194–1197. [PubMed]
22. Moriskey DE, Malotte CK, Choi P, et al. A patient education program to improve adherence rates with antituberculosis drug regimens. Health Ed Q. 1990;17(3):253–267. [PubMed]
23. Chaisson RE, Keruly JC, McAvinue S, Gallant JE, Moore RD. Effects of an incentive and education program on return rates for PPD test reading in patients with HIV infection. J Acquir Immune Dis Syndr. 1996;11:455–459. [PubMed]
24. Mangura BT, Passannante L, Reichman B. An incentive in tuberculosis preventive therapy for an inner city population. Int J Tuberc Lung Dis. 1997;1:576–578. [PubMed]
25. Schecter G. Supervised therapy in San Francisco. Clin Chest Med. 1997;18(1):165–168. doi: 10.1016/S0272-5231(05)70366-X. [PubMed] [Cross Ref]
26. El-Sadr W, Medard F, Barthaud V. Directly observed therapy for tuberculosis: the Harlem Hospital experience, 1993. Am J Public Health. 1996;86(8):1146–1148. [PMC free article] [PubMed]

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