| Title | Developing a directly administered antiretroviral therapy intervention for HIV-infected drug users: implications for program replication. |
| Publication Type | Journal Article |
| Year of Publication | 2004 |
| Authors | Altice, Frederick L., Jo Anne Mezger, John Hodges, Robert D. Bruce, Adrian Marinovich, Mary Walton, Sandra A. Springer, and Gerald H. Friedland |
| Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America |
| Volume | 38 Suppl 5 |
| Pagination | S376-87 |
| Date Published | 2004 Jun 1 |
| ISSN | 1537-6591 |
| Keywords | Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Directly Observed Therapy, Female, HIV Infections, HIV-1, Humans, Male, Patient Compliance, RNA, Viral, Self Administration, Substance-Related Disorders, Treatment Outcome, Viral Load |
| Abstract | Directly administered antiretroviral therapy (DAART) is one approach to improving adherence to among human immunodeficiency virus (HIV)-infected drug users. We evaluated the essential features of a community-based DAART intervention in a randomized, controlled trial of DAART versus self-administered therapy. Of the initial 72 subjects, 78% were racial minorities, and 32% were women. Social and medical comorbidities among subjects included homelessness (35% of subjects), lack of interpersonal support (86%), major depression (57%), and alcoholism (36%). At baseline, the median CD4+ cell count was 403 cells/mL and the median HIV-1 RNA load was 146,333 copies/mL (log10 5.31 copies/mL). During the prior 6 months, 33% of subjects had missed a medical appointment, and 47% had visited an emergency department. Although most subjects (67%) preferred to take their own medications, 76% would accept DAART if it were made compulsory. A methadone clinic was the DAART venue acceptable to the fewest subjects (36%), and a mobile syringe-exchange program was acceptable to the most subjects (83%). Adherence was higher for supervised than for unsupervised medication administration (P<.0001), a finding that supports use of daily supervision of once-daily regimens. Moreover, DAART should incorporate enhanced elements such as convenience, flexibility, confidentiality, cues and reminders, responsive pharmacy and medical services, and specialized training for staff. |
| DOI | 10.1007/s11904-011-0095-3 |
| Alternate Journal | Clin. Infect. Dis. |
