COACHING HELPS TEENS STICK TO TUBERCULOSIS MEDICATION                          By Aaron Levin, Science Writer Health Behavior News Service 

Intensive one-on-one coaching works better at helping Latino teenagers keep taking tuberculosis medicine than self-esteem counseling or conventional medical care, researchers say.                                                                                         

Measured over a nine-month treatment course, the young people who were coached took the highest average number of pills compared to the self-esteem and usual care groups. 

The study, by researchers from the Center for Behavioral Epidemiology and Community Health at San Diego State University, appears in the November issue of the American Journal of Public Health. Poor adherence — not taking medications as prescribed — is a major medical problem.  

The World Health Organization estimates that patients take only half of the drugs that doctors tell them to. The problem is especially bad with tuberculosis. Failing to take the full course of medication can lead to development of the disease in people with inactive tuberculosis infection. It can also contribute to drug-resistant strains of the disease-causing organism.  

The prevalence of tuberculosis in the Latino community is twice that of the general rate in the United States. 

So researcher Melbourne F. Hovell, Ph.D., M.P.H., and colleagues recruited 286 Latino adolescents in the San Diego area with latent tuberculosis infection to test which approach might work best to encourage the teens to take their medicine. All the adolescents were prescribed the drug isoniazid, taken once a day. 

The teens were randomly divided into three groups. One group got usual medical care: six to nine months of drug treatment, with return clinic visits scheduled at one- to three-month intervals. Along with their prescriptions, the second group received special coaching in adherence to their medications. 

Their coaches were bilingual Latino college students specially trained to educate the young patients about tuberculosis infection and treatment. The coaches helped the teens set adherence goals, followed by five 30-minute in-person sessions and seven 15-minute telephone sessions during the next six months. 

Counselors discussed why pills were taken or missed and how the teenagers could improve adherence. The third group also received isoniazid and was assigned to self-esteem counselors. The counselors encouraged the adolescents to talk about relationships and communications with family and friends and about cultural identity. The self-esteem counselors provided no information or advice about tuberculosis, referring any questions about the disease to physicians. Unannounced monthly interviews and urine tests were used to check whether the teens were taking their pills. 

“We believe that the combination of random urine assays and detailed interview measures provides the most accurate estimate of isoniazid adherence,” Hovell says. 

Results showed that the group coached for adherence took more pills on average than the comparison groups. Patients given the usual medical care took 150 pills on average (out of a possible 270 pills) over the nine-month period. 

The self-esteem group took an average of 155 pills, but the coached group took an average of 180 pills. The researchers note that the results raise questions about the true levels of adherence found in previous studies and in clinical practice. 

Participants in the study had lower adherence rates than reported by other investigators, but that may be due to the stricter measurement procedures. Half of the coached group completed treatment (defined as taking 180 pills within 270 days), indicating that more effort might be required, Hovell says. “These results suggest that more powerful interventions are needed to achieve at least 90 percent treatment completion rates among Latino adolescents,” he says. “Coaching of longer duration might result in substantially higher completion rates.” 

This research was funded by grants from the National Heart, Lung and Blood Institute, the Alliance Healthcare Foundation, and the Universitywide AIDS Research Program of the University of California. 

 FOR MORE INFORMATION: Health Behavior News Service: (202) 387-2829 or www.hbns.org. Interviews: Contact Melbourne F. Hovell at (858) 505-4772 or mhovell@projects.sdsu.edu. American Journal of Public Health: (202) 777-2511 or www.ajph.org. This story is also available online at www.hbns.org/news/latino10-30-03.cfm.

 

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