Behavioral Interventions for Control of TB
Behavioral Interventions for Control of TB
To compare alternative methods to ensure completion of treatment and preventive therapy for
 tuberculosis (TB) in inner cities, and to identify the most cost-effective methods to
 accomplish that. The basis for comparison included adherence rates and cost savings as
 primary outcomes, and other parameters such as patient satisfaction, development of social
 networks, and participation in support programs as secondary outcomes.

 Two clinical trials were conducted with patients from Harlem. Among those with active
 disease, a clinic-based surrogate family model was compared to traditional community-based
 directly observed therapy (DOT). Among those eligible for preventive therapy, a
 community-based intervention conducted by trained graduates of a TB DOT program (peer
 workers) was compared to traditional self-administered preventive treatment.
Tuberculosis was on the decline from the mid 1950s until the mid 1980s; however, the United
 States is now experiencing a resurgence of tuberculosis. In 1992, approximately 27,000 new
 cases were reported, an increase of about 20 percent from 1985 to 1992. Not only are
 tuberculosis cases on the increase, but a serious aspect of the problem is the recent
 occurence of outbreaks of multidrug resistant (MDR) tuberculosis, which poses an urgent
 public health problem and requires rapid intervention.

 Control programs involve two major components. First, and of highest priority, is to detect
 persons with active tuberculosis and treat them with effective antituberculosis drugs, which
 prevents death from tuberculosis and stops the transmission of infection to other persons.
 Treatment of active tuberculosis involves taking multiple antituberculosis drugs daily or
 several times weekly for at least six months. Failure to take the medications for the full
 treatment period may mean that the disease is not cured and may recur. If sufficient
 medications are not prescribed early and taken regularly, the tuberculosis organism can
 become resistant to the drugs, and the drug resistant tuberculosis then may be transmitted to
 other persons. Drug resistant disease is difficult and expensive to treat, and in some cases,
 cannot be treated with available medications.

 The second major goal of control efforts is the detection and treatment of persons who do not
 have active tuberculosis, but who have latent tuberculosis infection. These people may be at
 high risk of developing active tuberculosis. The only approved treatment modality for
 preventive therapy requires treatment daily or twice weekly for a minimum of six months, and
 many patients do not complete the full course of therapy. Public and patient programs are
 needed to increase the awareness of the problems associated with tuberculosis control.

 The study is part of the NHLBI initiative "Behavioral Interventions for Control of
 Tuberculosis" . The concept for the initiative originated from the National Institutes of
 Health Working Group on Health and Behavior. The Request for Applications was released in
 October, 1994.
Inclusion Criteria:

 -Patients with suspected and confirmed TB

 Exclusion Criteria:

 -Patients that are not a part of the therapy program established at Harlem Hospital, New
 York City