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Behavioral Ecological Model


Few programs have been directed to prevent TB by means of aggressive treatment of latent disease. This Demonstration and Education Research project will test a public health model of screening, preventive INH treatment and adherence counseling plus medical education of primary care clinicians to enhance their skills and attention to TB control. The integration of behavioral science, continuing education training for primary health care providers, and support by the County Health Department is based on recent recommendations from CDC investigators (Sumarjoto), Social Learning Theory, and our research experience. We will test both a behavioral adherence intervention for Latino adolescents with latent disease and a medical education program designed to enhance primary care (community clinic) practitioners' treatment of active and latent TB infection. We will test this combined model with Latino adolescents, who represent one of the largest underserved populations within which TB is epidemic. The next "phase" of TB control will require decentralized primary care services provided by community clinics and private practitioners and it will require the identification and treatment of latent as well as active disease. To extend the proposed model to most community clinic settings, it will be necessary to demonstrate outcome effectiveness as well as cost effectiveness in relation to the costs of failing to control latent TB in this population. Public school adolescents will be screened and 300 PPD positive male and female Latino youth (13-18 yrs.) will be assigned at random to either usual medical treatment, usual medical treatment plus non-directed (attention control) counseling, or to medical care plus behavioral adherence counseling. Concurrently participating clinic personnel will receive training in TB control. The primary specific aims are to determine whether behavioral counseling increases clinic attendance and adherence to prescribed INH medication relative to controls and to determine if training increases professionals' knowledge and practice of TB screening and control treatment. Pill count and reported estimates of adherence will be verified by random urine assays. Repeated measures analyses of the differential change in adherence over 6-9 months will be used to test the adherence intervention. Repeated measures analyses also will be used to assess the effects of professional training. Exploratory analyses will identify correlates of adherence, and cost effectiveness analyses will assess the relative costs of screening and treatment compared to the costs of not controlling TB. The combined assessment of both outcomes and relative costs for professional training, Health Department and Lung Association support plus behavioral adherence counseling will provide a public health model for prevention of TB among Latino adolescents. Adapted procedures might also prove effective for treatment of latent disease among other minority and high-risk populations.

Principal Investigator: Mel Hovell, PhD, MPH

Project Coordinator: Carol Sipan, RN, MPH

Funded 1995 - 2000

Source: National Heart, Lung and Blood Institute


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