Rachel Waltenburg Transcultural fund
recipient
Summer 2002, Russia
Qualitative Evaluation of an Incentive Program for
Tuberculosis Patients
in Ivanovo Oblast, Russia
In Russia, an estimated 26 million individuals, or one
in six people, are infected with TB. With an incidence of 156 per 100,000
population, the Russian Federation currently has the ninth-highest incidence
of TB in the world. This summer I spent a month in Ivanovo oblast, Russia.
Ivanovo oblast is close in size to that of Connecticut. Ivanovo city,
which is the governmental center of the oblast, is located 300 km northeast
of Moscow. It is the largest city in the oblast with a population of
100,000. While there, I completed a qualitative evaluation of an incentive
program for tuberculosis patients. The incentive program is a collaborative
effort between the Ivanovo Tuberculosis Dispensary, the CDC, and the
WHO. The patient incentive program is part of an overall plan to improve
the rates of treatment completion. The treatment of routine TB, without
complications, requires six months of continuous treatment. Noncompliance
occurs due to a variety of reasons. The patient begins to feel better,
lack of transportation, having to wait in line, lack of child care,
interference with work, alcoholism, and poor socioeconomic conditions
are just a few of the reasons.
In an effort to improve adherence to treatment, patients were offered
a monthly food package worth 100 rubles (~$3.20). The only requirement
for receipt of the food package is adherence, which is defined as missing
zero doses for inpatients and two or fewer doses for outpatients over
the course of the entire month. Patients who adhere to their treatment
regimens receive a food package at the end of every month. This food
package seems to be a helpful incentive as many patients are of lower
socioeconomic status and are often unable to work while undergoing treatment.
My project involved the development of two semi-structured questionnaires
before leaving Atlanta, one for patients and one for staff members.
The questionnaires were then used to interview patients and staff members
who participated in the incentive program to determine overall perceptions
of the program and ways the program could be improved. With the help
of two interpreters, I was able to complete 135 patient and staff interviews
over a three-week period. Initial analysis of the patient data indicates
that most patients were satisfied with the food packages. The biggest
surprise was that only 46% of compliant patients and 29% of noncompliant
patients understood that adherence to treatment was a requirement for
receipt of the food packages. Most patients thought that the food package
was simply a nutritional supplement. This finding is worrisome because
it is difficult to use the food package as an incentive for adherence
to treatment when over half of the patients do not understand the purpose
of the program. Another finding was that many patients were not satisfied
with the educational material they received about tuberculosis. The
quality and quantity of the nutrition in the inpatient facilities was
another concern of patients.
This study has helped to reaffirm my interests in epidemiology and international
public health and also the direction of my career. Completing this project
was an important supplement to my formal classroom education. Field
work is a vital component of public health and one that many students
do not get a chance to experience. This project has allowed me to apply
the skills I learned in class and build confidence in my abilities as
an investigator. The Transcultural Experience Award has also allowed
me to interact with persons of another culture and to participate in
a worthwhile public health project.
The above picture was taken at the tuberculosis dispensary in Rodniki,
a district in Ivanovo oblast. Mila, one of my interpreters, is on the
right and we are wearing respirators, which were necessary when interviewing
infectious TB patients.
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