Doubts about DOT: antiretroviral therapy for resource-poor countries.
BACKGROUND
Directly observed therapy programs developed for tuberculosis (TB) have been suggested as a model for the provision of HIV medications in resource-poor countries in order to ensure adherence and prevent drug resistance.


METHODS
Opinions were formed based on a review of scientific literature regarding the effectiveness of witnessed dosing in directly observed TB therapy programs, adherence to HIV antiretroviral therapy in resource-rich and resource-poor settings, relationship between adherence and HIV antiretroviral drug resistance, HIV viral load and risk of HIV transmission, and stigmatization concerns related to HIV and TB in resource-poor settings.


CONCLUSIONS
We suggest that the enthusiasm for HIV directly observed therapy programs is premature based on: equivocal evidence that witnessed dosing is superior to self administered therapy; mistaken assumptions that resource-poor countries are a 'special case' with respect to adherence; possible paradoxical impact of good adherence on HIV drug resistance; unproven efficacy of antiretroviral therapy in preventing HIV transmission; and potential stigmatization of daily antiretroviral dosing.
Liechty
Cheryl A
CA
Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, Kampala, Uganda.
Bangsberg
David R
DR
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D023801:Directly Observed Therapy / Q000191:economics / Q000706:statistics & numerical data*; D016527:Drug Costs; D024921:Drug Resistance, Multiple, Viral; D006801:Humans; D010349:Patient Compliance; D028701:Patient Rights; D011203:Poverty; D040841:Resource Allocation; D014376:Tuberculosis / Q000188:drug therapy / Q000517:prevention & control