title: Directly administered antiretroviral therapy in an urban methadone maintenance clinic: a nonrandomized comparative study.
abstract: Methadone-maintenance treatment clinics are strategically appealing sites for provision of directly administered antiretroviral therapy (DAART) to human immunodeficiency virus type 1 (HIV-1)-infected injection drug users (IDUs). We initiated an ongoing DAART protocol at a university-associated methadone clinic in April 2001, which continues to enroll participants. Participants ingested antiretroviral medications under direct supervision on days they attended the clinic; evening doses and doses on "methadone take-home days" were self-administered. Comparison IDUs receiving either standard care or treatment-adherence support were randomly selected from the population of the HIV-1 clinic where DAART participants received their primary care for HIV-1 infection, with frequency matching by sex, prior antiretroviral exposure, and receipt of methadone therapy. In an intention-to-treat analysis, 79% of DAART participants achieved HIV-1 RNA levels of <400 copies/mL by month 6 of therapy, compared with 54% in the standard care group (P=.035) and 48% in the adherence support group (P=.008). The preliminary results of this study both suggest that DAART can be feasible and acceptable to patients in a methadone clinic setting and provide impetus for further study of this treatment strategy in randomized controlled trials.
authors.affiliation: Johns Hopkins University, Baltimore, MD 21287, USA. glucas@jhmi.edu
authors.forename: Gregory M
authors.initials: GM
authors.lastname: Lucas
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Weidle
authors.forename: Shannon
authors.initials: S
authors.lastname: Hader
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D023801:Directly Observed Therapy; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D010349:Patient Compliance; D019966:Substance-Related Disorders / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D008691:Methadone