The purpose of this research is to examine the issue of patient compliance with medication protocols in cases of serious risks to the public health, with special emphasis on tuberculosis treatment.
One of the most striking features of US urban life since the mid-1980s has been the statistical rise in the incidence of TB. The early 1990s heralded a significant increase in TB diagnoses in a variety of settings that persists to the present day. In New York City alone, some 600,000 TB cases had been identified by 1993, and of those cases, 40% were also infected with HIV (Goldsmith, 1993; Goosby & Others, 1993). TB cases reached a rate of between 75 and 500 per 100,000 in correctional-facility settings by the end of 1992, compared to some 14 per 100,000 in the general population (Skolnick, 1992), prompting correctional officials to reinstitute x-ray rather than subcutaneous diagnosis protocols to handle the volume of cases or suspected cases of disease. In Los Angeles, a deadly combination of TB, HIV, homelessness, and immigration was identified as reaching epidemic proportions over the course of the 1990s (Barnes, 1997). Complicating the rise in TB incidence was that some strains of the disease developed resistance to traditional drug therapies, including multiple drugs (Goldsmith, 1993; Joseph, 1993).
Ironically, it was just at the time TB began to make serious inroads into US society that a good deal of public funding for health care was cut, placing a severe strain on public-health entities' ability to perform optimal delivery of health care (Hamburg, 1993). The effects of that were felt particularly in crowded and impoverished urban areas, where clusters of migrant workers, racial minorities, and new immigrants--each group statistically associated with poverty--contributed to the problem (Gostin, 1993).
Further complicating the whole matter in recent years has been the difficulty of ensuring that patients diagnosed with TB com...