Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique.
OBJECTIVE
To assess the efficacy of a peer-delivered intervention to promote short-term (6-month) and long-term (12-month) adherence to HAART in a Mozambican clinic population.


METHODS
A 2-arm randomized controlled trial was conducted between October 2004 and June 2006.


METHODS
Of 350 men and women (> or = 18 years) initiating HAART, 53.7% were female, and 97% were on 1 fixed-dose combination pill twice a day.


METHODS
Participants were randomly assigned to receive 6 weeks (Monday through Friday; 30 daily visits) of peer-delivered, modified directly observed therapy (mDOT) or standard care. Peers provided education about treatment and adherence and sought to identify and mitigate adherence barriers.


RESULTS
Participants' self-reported medication adherence was assessed 6 months and 12 months after starting HAART. Adherence was defined as the proportion of prescribed doses taken over the previous 7 days. Statistical analyses were performed using intention-to-treat (missing = failure).


RESULTS
Intervention participants, compared to those in standard care, showed significantly higher mean medication adherence at 6 months (92.7% vs. 84.9%, difference 7.8, 95% confidence interval [CI]: 0.0.02, 13.0) and 12 months (94.4% vs. 87.7%, difference 6.8, 95% CI: 0.9, 12.9). There were no between-arm differences in chart-abstracted CD4 counts.


CONCLUSIONS
A peer-delivered mDOT program may be an effective strategy to promote long-term adherence among persons initiating HAART in resource-poor settings.
Pearson
Cynthia R
CR
Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA. pearsonc@u.washington.edu
Micek
Mark A
MA
Simoni
Jane M
JM
Hoff
Peter D
PD
Matediana
Eduardo
E
Martin
Diane P
DP
Gloyd
Stephen S
SS
D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D023801:Directly Observed Therapy; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015497:HIV-1; D006801:Humans; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D010349:Patient Compliance; D016896:Treatment Outcome
D044966:Anti-Retroviral Agents
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