Background: The efficacy of a nurse case-managed intervention was evaluated in subsamples of participants with one of the following characteristics: female gender, African American ethnicity, recruited from a homeless shelter, a history of military service, lifetime injection drug use, daily alcohol and drug use, poor physical health, and a history of poor mental health.
Objective: To determine whether a validated nurse case-managed intervention with incentives and tracking would improve adherence to latent tuberculosis infection treatment in subsamples of homeless persons with characteristics previously identified in the literature as predictive of nonadherence.
Methods: A prospective 2-group site-randomized design was conducted with 520 homeless adults residing in 12 homeless shelters and residential recovery sites in the Skid Row region of Los Angeles from 1998 to 2003.
Results: Daily drug users, participants with a history of injection drug use, daily alcohol users, and persons who were not of African American race or ethnicity had particularly poor completion rates, even in the nurse case-managed intervention program (48%, 55%, 54%, and 50%, respectively). However, the intervention achieved a 91% completion rate for homeless shelter residents and significantly improved latent tuberculosis infection treatment adherence in 9 of 12 subgroups tested (odds ratios = 2.51-10.41), including daily alcohol and drug users, when potential confounders were controlled using logistic regression analysis.
Discussion: Nurse case management with incentives appears to be a good foundation for increasing adherence to 6-month isoniazid treatment in a variety of homeless subgroups and, in particular, for sheltered homeless populations. However, additional social-structural and environmental strategies are needed to address those at greatest risk of nonadherence.
Adeline Nyamathi, PhD, ANP, FAAN, is Professor and Audrienne H. Moseley Endowed Chair in Community Health Research, School of Nursing, University of California, Los Angeles.
Payam Nahid, MD, MPH, is Assistant Adjunct Professor, Division of Pulmonary and Critical Care, University of California, San Francisco.
Jill Berg, PhD, RN, is Associate Professor, University of California, Irvine.
Joe Burrage, PhD, RN, is Associate Professor, University of Indiana, Indianapolis.
Ashley Christiani, MD, is Assistant Clinical Professor, David Geffen School of Medicine; Salah Aqtash, MSN, PhD, was a Doctoral Student, School of Nursing; Donald Morisky, ScD, is Professor, School of Public Health; and Barbara Leake, PhD, is Senior Statistician, School of Nursing, University of California, Los Angeles.
Accepted for publication September 27, 2007.
This research was funded by the National Institutes of Health (NIH) through the National Institute on Drug Abuse DA11145 and the NIH Roadmap for Medical Research 1 KL2 RR024130.
Corresponding author: Adeline Nyamathi, PhD, ANP, FAAN, Audrienne H. Moseley Endowed Chair in Community Health Research, School of Nursing, University of California, Los Angeles, Box 951702, 2-256 Factor Bldg., Los Angeles, CA 90095-1702 (e-mail: email@example.com).