Behavioral Interventions for Control of Tuberculosis
Condition: Lung Diseases; Tuberculosis
MeSH terms: Tuberculosis; Lung Diseases
Study type: Observational

Summary: 
      To develop and test various educational strategies targeting primarily minority TB-infected
      adolescents at two health centers in Los Angeles in an experimental design to assess the
      relative effectiveness on medication adherence, appointment keeping, and completion of
      therapy.
    

Detailed description: 
      BACKGROUND:

      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 tubercuosis 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.

      DESIGN NARRATIVE:

      The educational content and modalities were based on an intervention-oriented model of
      behavioral action derived from the theory of reasoned action, the theory of planned behavior,
      and the transtheoretical model. An experimental four group design was used to assess the
      independent and combined effects of peer counseling, a participant/parent contingency
      contract intervention, and a combination of peer counseling and contingency contracting,
      compared with a usual care control group.

      Beginning July 15, 1996 a total of 794 participants were recruited and randomly assigned to
      one of the four groups. In addition to assessing the impact of the intervention, analyses
      compared the relative importance of the hypothesized influencing and mediating factors on
      behavior. Cost-effectiveness analyses were also conducted. During the later stages of the
      study, clinic staff from throughout Los Angeles County were trained and encouraged to
      integrate the strategies that appeared to be effective into their clinic setting.

      The study completion date listed in this record was obtained from the "End Date" entered in
      the Protocol Registration and Results System (PRS) record.