Effects of an incentive and education program on return rates for PPD test reading in patients with HIV infection.

To determine the impact of a food voucher incentive and patient education program on compliance with tuberculin skin test (PPD, purified protein derivative) performance in HIV-infected adults, we analyzed return rates for PPD reading for patients at our urban HIV clinic. The groups studied included patients who received no intervention (controls), patients offered a food voucher incentive, and patients offered a food voucher and patient education intervention. Return rates for PPD reading were 96 (35%) of 272 for the control group, 111 (48%, p = 0.004) of 229 for the food voucher group, and 96 (61%, p < 0.0001) of 158 for the food voucher and patient education group. By univariate analysis, black patients (p = 0.01), males (p = 0.01), older patients (p = 0.04), city residents (p = 0.001), and injection drug users were more likely to return for PPD reading. By logistic regression, food voucher, food voucher plus education, city residence, and male sex were significantly associated with return for PPD reading. Two simple, inexpensive interventions were found to increase compliance with tuberculin skin test performance in HIV-infected adults. Additional interventions are required to achieve better rates of return for PPD reading.

[1]  J. Pape,et al.  Effect of isoniazid prophylaxis on incidence of active tuberculosis and progression of HIV infection , 1993, The Lancet.

[2]  D. Vlahov,et al.  Prevalence of tuberculin positivity and skin test anergy in HIV-1-seropositive and -seronegative intravenous drug users. , 1992, JAMA.

[3]  D. Solomon,et al.  Reading the tuberculin skin test. Who, when, and how? , 1988, Archives of internal medicine.

[4]  J. Sbarbaro.  Compliance: inducements and enforcements. , 1979, Chest.

[5]  D. Simons-Morton,et al.  Characteristics of controlled studies of patient education and counseling for preventive health behaviors. , 1992, Patient education and counseling.

[6]  P D Mullen,et al.  Clinical trials of patient education for chronic conditions: a comparative meta-analysis of intervention types. , 1985, Preventive medicine.

[7]  R. Cebul,et al.  Improving compliance with breast cancer screening in older women. Results of a randomized controlled trial. , 1995, Archives of internal medicine.

[8]  S. Vermund,et al.  A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. , 1989, The New England journal of medicine.

[9]  R. Chaisson,et al.  Race, sex, drug use, and progression of human immunodeficiency virus disease. , 1995, The New England journal of medicine.

[10]  F. Curry.  Neighborhood clinica for more effective outpatient treatment of tuberculosis. , 1968, The New England journal of medicine.

[11]  R. Huebner,et al.  The tuberculin skin test. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  P. Selwyn,et al.  High risk of active tuberculosis in HIV-infected drug users with cutaneous anergy. , 1992, JAMA.

[13]  R. Chaisson,et al.  Racial differences in the use of drug therapy for HIV disease in an urban community. , 1994, The New England journal of medicine.

[14]  D. Snider,et al.  Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention. , 1994, American journal of respiratory and critical care medicine.

[15]  J. Alberdi,et al.  Risk for Developing Tuberculosis among Anergic Patients Infected with HIV , 1993, Annals of Internal Medicine.