Community isoniazid prophylaxis program in an underdeveloped area of Alaska.
A controlled trial of isoniazid prophylaxis for tuberculosis was conducted in 1958-60 in the service area of the Public Health Service hospital at Bethel, Alaska. Other pilot trials ensued. The recommended dose of isoniazid was approximately 5 mg. per kilogram of body weight, to be taken in a single dose each day for 1 year. Heavy reliance was placed on local personnel to distribute the medication and to motivate the people to participate. Approximately 80 percent of the population participated to some extent in the program. Children were most likely to take the medication as recommended; older adults tended to do poorly. Participation was poor in Bethel, a town of 1,652 persons. Participation was much better in the smaller villages and was best in the more remote areas. Subsequent observation indicates that new tuberculosis case rates have been high among persons who took little or no isoniazid and low among those who took the medication regularly. The program demonstrated that a large proportion of the population could be motivated to take daily medication for a long period with minimal professional supervision.