Behavioral Interventions for the Control of Tuberculosis Among Adolescents

Abstract

SYNOPSISObjectives. Activation of latent tuberculosis infection into tuberculosis disease (TB), the primary killer among infectious diseases worldwide, can be prevented with six months of anti-TB medication. A large percentage of adolescents started on medication, however, fail to complete their treatment. The authors developed and tested the effects of innovative educational strategies on infected adolescents at two health centers serving ethnically diverse populations.Methods. The authors used a randomized experimental four-group design to assess the independent and combined effects of peer counseling and a participant-parent contingency contract intervention.Results. A total of 794 adolescents were recruited into the study, for a 79% participation rate. The overall rate of treatment completion was 79.8%. Selfefficacy for medication-taking behavior at post-test correlated strongly with completion of care (R = 0.367, p = 0.002). Participants randomized to the peer counseling groups demonstrated significantly greater improvements in selfefficacy and mastery than the usual care control group. Based on the study results, continuing education seminars and workshops were implemented for TB control staff at the two health clinics and for all TB Control Division staff at the Los Angeles County Health Department. Educational materials and a training manual for enhancing completion of treatment of latent TB infection through tailored educational approaches were developed and disseminated to the clinics.Conclusions. Health education and incentives are helpful adjuncts to the completion of treatment for latent tuberculosis infection in adolescents.

A Systematic Review of Adherence-Enhancing Interventions in Adolescents Taking Long-term Medicines

“…The adolescent's family was also involved as active participants of the intervention, above and beyond providing consent, in seven studies [38,41,[45][46][47][48][49]. In all, 12 of the AEI studies were conducted in the United States [38 -49] and 10 of the interventions involved adolescents with type 1 diabetes mellitus (T1DM) [38 -41,46 -50,53].…”

“…Alternative delivery sites, used alone or in addition to the clinic, included the patients' homes [41,43,45,46,50], schools [52], and in four cases, various venues including community facilities were considered [40,41,43,46]. One intervention was based on text messaging [53].…”

“…Two interventions were peer-led [44,45], whereas the remaining three incorporated the use of adult interventionists acting either as a rolemodel [40], as an adherence coach (college students) [43], or as a diabetes personal trainer [46].…”

Meta-analysis of factors related to health services that predict treatment default by tuberculosis patients

“…Hovell et al 62 Dick et al 42 Subtotal Subtotal Demissie et al 67 Alvarez-Gordillo et al 66 Case-control Barnwell et al 38 Intervention White et al 58 Chaisson et al 52 Morisky et al 56 Subtotal …”

Improving medication adherence in patients with chronic disease using a targeted and tailored approach

“…261 A six-month American study found that peer counselling for adolescents did not have an effect on self-reported treatment completion rates. 262 Peer support group therapy for adolescents with HIV showed no change in adherence, according to physician reports. 263 A five-month clinic-wide social marketing campaign was conducted to improve adherence to antiretroviral therapy.…”