ACCEPTANCE OF ISONIAZID PREVENTIVE THERAPY BY HEALTH-CARE WORKERS AFTER TUBERCULIN SKIN-TEST CONVERSION

Objective.-To examine health care workers' (HCWs') acceptance of and a dherence to isoniazid preventive therapy in the setting of a comprehen sive tuberculin skin-testing program. Design.-Descriptive case series. Setting.-University-affiliated inner-city public hospital in Atlanta, Ga. Participants.-A total of 125 HCWs (91 hospital employees and 34 h ouse staff or medical students [the physician group]) who had a positi ve tuberculin skin test between July 1992 and January 1994 and were of fered isoniazid preventive therapy. Interventions.-Health care workers with a recent tuberculin skin test conversion were required to have a chest x-ray performed and see a physician and were encouraged but not required to undergo preventive therapy. Main Outcome Measures.-Accept ance and initiation of preventive therapy with isoniazid by HCWs, comp letion of at least 6 months of preventive therapy, and differences bet ween the employee and physician groups. Results.-All 125 HCWs with a r ecent positive tuberculin skin test had a chest radiograph performed, 123 (98.4%) saw a physician, and 105 (84%) initiated preventive therap y. Sixty-nine (66%) of the 105 HCWs who initiated preventive therapy ( 55% of the 125 total) completed at least 6 months of isoniazid therapy . More of the physician group than of the employee group completed pre ventive therapy (25 of 34 [74%] vs 44 of 91 [48%], respectively; P<.01 ). Of the 36 HCWs who started but did not complete preventive therapy, 12 discontinued therapy because of an adverse drug effect and 24 were nonadherent. Conclusions.-Acceptance of tuberculosis preventive thera py by HCWs was high in the setting of a comprehensive tuberculin skin- testing program, and completion of therapy was much higher in the phys ician group than in previously reported series.