SUCCESSFUL ADHERENCE TO OBSERVED PROPHYLAXIS AND TREATMENT OF TUBERCULOSIS AMONG DRUG-USERS IN A METHADONE PROGRAM

Incomplete antituberculous chemoprophylaxis and treatment are major ca uses of the resurgence of tuberculosis, often drug-resistant, among dr ug users. We offered directly observed antituberculous chemoprophylaxi s (n = 102) or treatment (n = 12) to eligible methadone maintenance tr eatment patients. Methadone dosing was not contingent upon ingestion o f antituberculous medication(s). No material incentives were provided. Ninety (88%) prophylaxis and 9 (75%) treatment patients were administ ered greater than or equal to 5 weekly doses of antituberculous medica tions during greater than or equal to 80% of 4740 patient-weeks. The m ajority of patients were HIV-seropositive. Active substance abuse was not associated with diminished adherence. Over 80% of patients complet ed or were still receiving therapy at the end of the study. Adherence to and completion of directly observed antituberculous therapy can thu s be attained by drug users in treatment, despite ongoing drug misuse. Substance abuse treatment programs provide opportunities for enhanced compliance, and should thus be viewed as critical components of strat egies to address the tuberculosis epidemic in drug users.