Prevention and Control of Infectious and Chronic Diseases Using Community-Based Research Initiatives in the Domestic and Global Scene

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Principal Investigator: Donald Morisky

Patient non-adherence to chronic and long-term disease regimens is a global problem, and promoting patient adherence is a major clinical challenge. Medication non-adherence is associated with high hospitalization and morbidity rates and premature mortality. Our research has been directed to the identification of psychosocial and environmental determinants of adherence behavior among patients diagnosed with various chronic and infectious health conditions. Studies in many clinical and community locations identified problems with the asymptomatic nature of the disease, complexity of the medical regimen, cost, provider-patient misunderstanding, and miscommunication. Studies conducted in outpatient settings identified the significance of trained peer educators who counseled adolescents on anti-tuberculosis treatment for latent tuberculosis infection. Adolescents randomized to the treatment group had significantly higher proportions of completion of care compared to those receiving standard care.  A 10-year longitudinal study in the Philippines identified significant reductions in STIs for female bar workers assigned to the combination of peer counseling and manager reinforcement compared to those assigned to either group or a standard care group. Similar findings resulted among peer-counseling interventions directed to potential high-risk male customers.  The results of this study are now being disseminated as a model program for the prevention of HIV/AIDS in developing countries throughout the world. Research is now being conducted in China to assess the feasibility of integrating the successful components of HIV prevention interventions into the health care system.