title: From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston.
abstract: Like tuberculosis, human immunodeficiency virus (HIV) disease is associated with poverty and social inequalities, conditions that hamper the delivery of care. Like tuberculosis, treatment of HIV infection requires multidrug regimens, and the causative agent acquires drug resistance, which can be transmitted to others. A pilot project in rural Haiti introduced DOT-HAART (directly observed therapy with highly active antiretroviral therapy) for the care of patients with advanced acquired immune deficiency syndrome. A similar DOT-HAART effort was launched in Boston for patients with drug-resistant HIV disease who had experienced failure of unsupervised therapy. In both settings, community health promoters or accompagnateurs provide more than DOT: they offer psychosocial support and link patients to clinical staff and available resources. DOT-HAART in these 2 settings presents both challenges and opportunities. These models of care can be applied to other poverty-stricken populations in resource-poor settings.
authors.affiliation: Partners In Health and Harvard Medical School, Boston, Massachusetts 02120, USA. hbehforouz@partners.org
authors.forename: H L
authors.initials: HL
authors.lastname: Behforouz
authors.forename: P E
authors.initials: PE
authors.lastname: Farmer
authors.forename: J S
authors.initials: JS
authors.lastname: Mukherjee
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001900:Boston; D003153:Community Health Services; D003695:Delivery of Health Care; D023801:Directly Observed Therapy; D004352:Drug Resistance, Microbial; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006205:Haiti; D006801:Humans; D010349:Patient Compliance; D010865:Pilot Projects; D011203:Poverty; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*
chemical_list: D019380:Anti-HIV Agents; D000995:Antitubercular Agents