The effects of increasing incentives on adherence to tuberculosis directlyobserved therapy

SETTING: Six New York State Department of Health tuberculosis (TB) directly observed therapy (DOT) programs in public, private and community facilitie s in New York City. OBJECTIVE: A key feature of the TB DOT program was provision of incentives to motivate patients and increase adherence to therapy. The study hypothesi s was that adherence will improve as the value of incentives increases and bonuses are added in a schedule of increasing rewards. DESIGN: The study population consisted of 365 patients in six inner city TB DOT programs. Interviews, clinical data and attendance records for 3+ year s were analyzed. RESULTS: Patients who adhered (attending 80% of pre scribed DOT visits each month of treatment) and those who did not were similar on seven demographi c factors (e.g., age and sex), but were significantly different on clinical and social variables. Previous TB, resistance to rifampin, human immunodef iciency virus infection, psychiatric illness, homelessness, smoking and dru g use were related to non-adherence. High adherence was significantly assoc iated with fewer months in treatment (P < 0.016), Logistic regression showe d that the odds that a patient would adhere to therapy were greater with in creased incentives. Odds of adherence were significantly lower with rifampi n resistance and psychiatric illness. CONCLUSION: Increasing incentives is associated with improved adherence to therapy in inner city TB populations.