IMPLICATIONS OF DIRECTLY OBSERVED THERAPY IN TUBERCULOSIS-CONTROL MEASURES AMONG IDUS

Tuberculosis (TB) is a rapidly growing problem among injecting drug us ers (IDU), especially those infected with human immunodeficiency virus . The authors review IDUs' responses to current TB control strategies and discuss the implications of their findings for the proposed implem entation of directly observed therapy (DOT), a method for ensuring tha t patients take prescribed medication. Field workers carried out 210 e thnographic interviews with 68 IDUs in a Brooklyn, NY, community durin g 1990-93. Case studies suggested that many IDUs are uninformed about TB and often misinformed about their personal TB status. Ethnographic interviews and observations indicated that the threat of TB-related in voluntary detainment may lead IDUs to avoid TB diagnostic procedures, treatment for TB, or drug abuse treatment, and to avoid AIDS outreach workers and other health-related services. IDUs who tested positive fo r the purified protein derivative (PPD) of TB sometimes have left hosp itals before definitive diagnoses were made, because of a perceived la ck of respectful treatment, fear of detention, or lack of adequate met hadone therapy to relieve the symptoms of withdrawal from drugs. Curre nt TB diagnosis and treatment systems are, at best, inadequate. The th reat of TB-related detention discourages some IDUs from seeking any ty pe of health care. There is an urgent need to educate IDUs about TB an d to educate and sensitize health care providers about the lifestyles of IDUs. DOT may help in servicing this difficult-to-serve population, particularly if techniques are incorporated that have been developed for other successful public health interventions for IDUs.