Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults.

Abstract

Objective: To assess predictors of latent tuberculosis infection (LTBI) completion by using structural equation modeling (SEM) among homeless adults, a group at great risk for LTBI and active tuberculosis (TB). LTBI therapy is effective in stemming the progression to active TB, yet treatment adherence among homeless persons is difficult to attain. Design: By using SEM, the authors assessed predictors of LTBI completion among a sample of 494 homeless adults in Los Angeles, CA, who received either a nurse case-managed program (NCM) or a usual care program. Main Outcome Measures: Latent variables were created with the baseline variables of site type, age, intervention status, dissatisfaction with health care, depression, TB risk assessment, alcohol use, heroin or cocaine use, and TB knowledge. Outcome variables included many of the same baseline variables as well as treatment completion. Results: LTBI treatment completion (100% adherence) was significantly and positively associated with participation in NCM, older age, and less heroin or cocaine use. NCM also predicted greater TB knowledge, greater ease of treatment, and more satisfaction with treatment (NCM completion rate ϭ 64%, control rate ϭ 42%). Conclusion:The culturally competent NCM program, combined with active tracking and incentives, was successful in a difficult-to-treat and highly transient population.

Evaluation of a school-based program for diagnosis and treatment of latent tuberculosis infection in immigrant children

“…However, using a larger definition for completion in children treated during 9 months (>80% of the total dose within 1 year), adherence rate poorly differed (65.1%). Other studies have tried to determine factors for failure of LTBI treatment completion, both in adults [29,[33][34][35][36][37][38][39][40][41][42][43] and in children [12,14,15,44,45]. Somatic complaints during isoniazid treatment have been reported in poorly adherent adolescents, especially in females [46], but we did not find such an association.…”

Incentives and enablers to improve adherence in tuberculosis

“…We excluded trials for the following reasons: patients in both trial arms were given the same incentive ( Nyamathi 2006 ); quasi‐randomized with randomization done either by day of the week ( Cheng 1997 ) or by the last digits in the participants' clinic record numbers ( Morisky 1990 ); cross sectional studies where one group was given the incentive and the other was not ( Cantalice Filho 2009 ; FitzGerald 1999 ; Yao 2008 ); or the main intervention was community health‐worker delivered TB treatment combined with food supplements ( Jahnavi 2010 ). In this review update, we excluded one new potentially eligible study because the control was an historical group of patients on treatment for TB ( Gärden 2013 ), and another study because the intervention was not randomized ( Chua 2015 ).…”

Health status and health behaviour of the Hungarian homeless people

“…In contrast to the previous ndings the prevalence of the neoplasm was relatively low among them (4). Several studies have been demonstrated that case management, health education, improvement of social skills and social support could improve the health literacy, the health services utilization and the adherence to the therapy (34)(35)(36)(37)(38).…”