title: Developing a directly administered antiretroviral therapy intervention for HIV-infected drug users: implications for program replication.
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.
authors.affiliation: Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut 06510-2283, USA. frederick.altice@yale.edu
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
authors.forename: Jo Anne
authors.initials: JA
authors.lastname: Mezger
authors.forename: John
authors.initials: J
authors.lastname: Hodges
authors.forename: Robert D
authors.initials: RD
authors.lastname: Bruce
authors.forename: Adrian
authors.initials: A
authors.lastname: Marinovich
authors.forename: Mary
authors.initials: M
authors.lastname: Walton
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Springer
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Friedland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D023801:Directly Observed Therapy; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics / Q000502:physiology; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012367:RNA, Viral / Q000032:analysis; D012646:Self Administration; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral