The 130th Annual Meeting of APHA

Abstract #36816

David C. Perlman, MD¹, Veronika Schoeb, MHA², Ann Nugent, BA², Leslie Horn, MPH², Patricia Friedmann, MS², and Don C. Des Jarlais, PhD². (1) Department of Medicine, Beth Israel Medical Center/Albert Einstein College of Medicine, First Avenue at 16th St., New York, NY 10003, 212-420-4470, dperlman@bethisraelny.org, (2) Department of Medicine, Beth Israel Medical Center, Milton and Carroll Petrie Division, First Avenue at 16th Street, New York, NY 10003

Objective: Syringe exchange programs (SEPs) have proven to be valuable sites to conduct tuberculin skin testing among active IDUs, and onsite delivery of TB preventive therapy (PT) at SEPs has been promising. However, those with reactive skin tests require chest x-rays (CXR) to exclude active TB prior to the initiation of TB PT, and adherence to referral for off-site CXRs has been problematic. Monetary incentives have been useful in improving adherence in various settings. We compared adherence to CXR referral among IDUs undergoing SEP-based TB screening before and after the implementation of incentives. Methods: TB screening was conducted at a storefront SEP in the Lower East Side in New York City. From 1995 - 1998, 106 IDUs were referred for CXRs based on skin testing. From 1999, 42 IDUs were referred for CXR with an incentive of $25 contingent on adherence. Results: The cohorts referred for CXR were comparable with respect to gender, ethnicity, injecting daily, unstable housing, alcohol intoxication, crack use, and proportion in drug treatment. The earlier cohort was slightly younger (mean age: 37.7 vs. 42.9, p=.01), however, adherence was not associated with age (p=.24). Forty IDUs (38%) adhered to CXR referral prior to the use of incentives compared with thirty (71%) with incentives (p=0.0002, RR=1.89, 95% CI=1.39-2.58). Conclusions: IDUs have a high prevalence of TB infection and are at high risk for active tuberculosis. Successful screening programs are important to control the endemic. Monetary incentives increase adherence of IDUs at SEPs to referral for CXRs.

Learning Objectives:

At the conclusion of the session, the participants will be able to
• evaluate the benefit of monetary incentives for adherence to preventive tuberculosis services
• understand how syringe exchange programs can be successfully used to provide medical services to drug users

Keywords: Needle Exchange Programs, Tuberculosis

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.