title: The acceptability of a directly-administered antiretroviral therapy (DAART) intervention among patients in public HIV clinics in Los Angeles, California.
abstract: Directly administered antiretroviral therapy (DAART) is an intensive adherence support strategy for highly active antiretroviral therapy (HAART) that requires patient acceptance to be effective. In one arm of a randomized adherence study, community workers (CW) delivered and observed ingestion of one HAART dose to participants five days a week for six months. We evaluated acceptability by study participation, retention, attendance and a satisfaction survey. Chi-square and nonparametric tests were used to examine differences between participants who did and did not complete DAART. Between November 2001 and March 2004, 416 eligible participants were identified; 250 were enrolled and 166 refused to participate (22 of these (13%) because of DAART specifically). Of the 82 randomized to DAART (70% Latino, 20% African American, 27% female and 69% foreign-born), 65 (79%) completed six months of DAART. Participants attended 6,953/7,390 (94%) appointments. Latinos were more likely to complete DAART compared to African Americans (OR=4.76, 95%CI=1.38, 16.44, p=0.01). In addition, foreign-born participants were more likely to complete DAART than US-born participants (OR=3.38, 95%CI=1.11-10.22, p=0.03). Participants completing DAART reported high rates of satisfaction. Retention, attendance and participant satisfaction suggest that DAART is an acceptable adherence support strategy in this public clinic population, particularly among Latino and foreign-born participants.
authors.affiliation: HIV Epidemiology Program, Los Angeles County Department of Health Services, Los Angeles, CA 90005, USA. wgarland@ladhs.org
authors.forename: W H
authors.initials: WH
authors.lastname: Garland
authors.forename: A R
authors.initials: AR
authors.lastname: Wohl
authors.forename: R
authors.initials: R
authors.lastname: Valencia
authors.forename: M D
authors.initials: MD
authors.lastname: Witt
authors.forename: K
authors.initials: K
authors.lastname: Squires
authors.forename: A
authors.initials: A
authors.lastname: Kovacs
authors.forename: R
authors.initials: R
authors.lastname: Larsen
authors.forename: N
authors.initials: N
authors.lastname: Potterat
authors.forename: M-N
authors.initials: MN
authors.lastname: Anthony
authors.forename: S
authors.initials: S
authors.lastname: Hader
authors.forename: P J
authors.initials: PJ
authors.lastname: Weidle
mesh_terms: D000328:Adult; D001741:Black or African American; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods / Q000523:psychology*; D023801:Directly Observed Therapy / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006630:Hispanic or Latino; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D017060:Patient Satisfaction; D015397:Program Evaluation; D017150:Public Sector