STRATEGIES TO INCREASE ADHERENCE WITH TUBERCULOSIS TEST READING IN A HIGH-RISK POPULATION

Objective. To determine the most effective strategy to encourage adher ence with tuberculosis test reading in a high-risk population. Design. Prospective randomized controlled trial. Setting/Participants. Consec utive sample of 627 children ages 1 to 12 years due for a tuberculosis (TB) test in an urban children's hospital outpatient department. One child per family was enrolled. Intervention. All families received edu cation regarding the importance of skin testing for TB and the need fo r follow-up, and written and verbal instructions regarding test readin g. Families were randomly assigned to one of five strategies for follo w-up TB test reading at 48 to 72 hours: 1) routine verbal and written instructions, 2) reminder phone call, 3) transportation tokens and toy on return, 4) withholding of school forms until time of reading and n eed to repeat TB test if not timely read, 5) parents taught to read in duration with nurse home visit. Those who did not have tests read at 4 8 to 72 hours by a trained professional were phoned 1 week later. Resu lts. The five groups did not differ with regard to TB risk factor scor e, maternal education, transportation source, or perceived importance of TB testing. Before the study the follow-up rate of TB test reading by a trained professional was 45%. Reading rates in this study were 58 %, 70%, 67%, 70%, and 72% for groups 1 to 5, respectively. In group 4, only 39% had school forms to be completed and their adherence rate wa s 84% (53/63). Compared to group 1, the only statistically significant improvement was in group 4, especially for those who needed school fo rms completed, and in group 5. Those not adhering in groups 1 to 4 did not differ from returnees with regard to TB risk factors, maternal ed ucation, transportation, or perceived importance of testing. The most common reasons for failing to return included forgetfulness, transport ation, and time constraints. Group 5 was stopped early because of diff iculty with nurse visits (N = 98). When told of the nurse visit, 9% (9 /98) families could not find a time for the visit. Seventeen percent ( 17/98) were visited but the child was not home, and 7% (7/98) were not visited because of a nurse scheduling problem. Conclusions. In a high -risk population, adherence with TB test reading is poor. However, edu cation and return of school forms at reading time can significantly im prove adherence. Although requiring larger investment in resources, vi siting nurses may also aid in test reading.