A randomized trial comparing standard outcomes in two treatment models for substance users with tuberculosis

Area of Science:

• Public Health
• Infectious Disease Control
• Substance Abuse Treatment

Background:

• Tuberculosis (TB) remains a significant public health challenge, particularly among vulnerable populations such as substance users.
• Directly Observed Therapy (DOT) is a strategy to improve treatment adherence and outcomes.
• Traditional DOT programs may face challenges in engaging hard-to-reach populations.

Purpose of the Study:

• To compare the effectiveness of two different models of DOT outreach workers in treating substance users with TB.
• To evaluate anti-tuberculosis treatment completion and adherence rates between standard and enhanced DOT interventions.

Main Methods:

• A randomized controlled trial was conducted involving substance users diagnosed with TB.
• Patients were assigned to either standard DOT by Chicago Department of Public Health (CDPH) personnel or enhanced DOT by previous substance-using outreach workers.
• Treatment completion and adherence were assessed, with housing instability identified as a predictor in multivariate analyses.

Main Results:

• The enhanced DOT arm demonstrated significantly higher treatment completion rates (85% vs. 61%) compared to the standard arm.
• Patients in the enhanced arm also had a significantly lower risk of missing DOT appointments.
• Housing instability was a significant predictor of both non-completion and missed appointments across both groups.

Conclusions:

• An enhanced DOT intervention, utilizing outreach workers with shared lived experiences, significantly improved TB treatment outcomes in substance users.
• The familiarity of enhanced-arm DOT workers with patients' social norms and life circumstances likely contributed to their increased effectiveness.
• Implementing successful DOT strategies for hard-to-reach populations requires tailored approaches that address individual circumstances and leverage relatable personnel.