title: Community outreach with weekly delivery of anti-retroviral drugs compared to cognitive-behavioural health care team-based approach to improve adherence among indigent women newly starting HAART.
abstract: Sustained virological suppression requires adherence to >95% of doses of therapy. Overall there is paucity of data on adherence interventions among women and post-intervention outcomes. In this pilot study, we evaluated a novel strategy of weekly delivery of medications (Directly Delivered Therapy: DDT) for six months using an outreach worker (ORW), among ARV naïve indigent women starting HAART and compared the 'during intervention' and 'post-intervention' outcomes to the health care team (a nurse educator, a case worker, a pharmacist and social worker/drug addictions counsellor) based approach termed Adherence Coordination Services (ACS) and the Standard of Care (SoC) historical referent group. The baseline characteristics of the three groups were comparable. The proportion of women who achieved sustained virologic suppression in 4-8 month period for DDT; ACS and SoC groups were 86% (18/21); 54% (6/11); and 36% (8/22) (P<0.004); and in the 10-14 month period were 80% (12/15); 54% (6/11) and 45%(10/22) (P=0.036 for DDT vs. SoC). Retention rate in the DDT was 87%, and 92% of 307 ORW visits were kept, and post-intervention satisfaction was high. Short-term weekly delivery of medications using a community based liaison is a feasible, acceptable and a cost-effective strategy for improving both short-term and perhaps long-term adherence among women initiating their first HAART regimen.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Baylor College Of Medicine, One Baylor Plaza, Room #465 EC, Houston, TX 77030, USA. fehmidav@bcm.tmc.edu
authors.forename: F
authors.initials: F
authors.lastname: Visnegarwala
authors.forename: M C
authors.initials: MC
authors.lastname: Rodriguez-Barradass
authors.forename: E A
authors.initials: EA
authors.lastname: Graviss
authors.forename: M
authors.initials: M
authors.lastname: Caprio
authors.forename: M
authors.initials: M
authors.lastname: Nykyforchyn
authors.forename: L
authors.initials: L
authors.lastname: Laufman
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003153:Community Health Services; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance; D010865:Pilot Projects; D013781:Texas; D016896:Treatment Outcome