title: Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique.
abstract: 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.
authors: Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA. pearsonc@u.washington.edu
authors: Cynthia R
authors: CR
authors: Pearson
authors: Mark A
authors: MA
authors: Micek
authors: Jane M
authors: JM
authors: Simoni
authors: Peter D
authors: PD
authors: Hoff
authors: Eduardo
authors: E
authors: Matediana
authors: Diane P
authors: DP
authors: Martin
authors: Stephen S
authors: SS
authors: Gloyd
mesh_terms: 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
chemical_list: D044966:Anti-Retroviral Agents
references: AIDS. 1999 Sep;13 Suppl 1:S61-72
references: 10546786
references: AIDS Patient Care STDS. 2002 Dec;16(12):609-16
references: 12542934
references: Ann Intern Med. 2000 Jul 4;133(1):21-30
references: 10877736
references: J Acquir Immune Defic Syndr. 2000 Nov 1;25(3):221-8
references: 11115952
references: Ann Intern Med. 2001 May 15;134(10):968-77
references: 11352698
references: AIDS Patient Care STDS. 2001 Apr;15(4):193-9
references: 11359661
references: AIDS. 2001 Jun 15;15(9):1181-3
references: 11416722
references: Clin Infect Dis. 2001 Oct 15;33(8):1417-23
references: 11550118
references: Behav Res Ther. 2001 Oct;39(10):1151-62
references: 11579986
references: J Acquir Immune Defic Syndr. 2003 Oct 1;34(2):191-4
references: 14526208
references: AIDS Care. 2004 Feb;16(2):199-211
references: 14676026
references: AIDS Care. 2004 Feb;16(2):219-30
references: 14676027
references: Antivir Ther. 2004 Feb;9(1):85-95
references: 15040540
references: Clin Infect Dis. 2004 Jun 1;38 Suppl 5:S429-36
references: 15156434
references: J Behav Med. 1993 Feb;16(1):45-63
references: 8433357
references: Enferm Infecc Microbiol Clin. 1999 Feb;17(2):78-81
references: 10193067
references: Clin Infect Dis. 2005 Jan 1;40(1):158-63
references: 15614706
references: Clin Ther. 2005 Feb;27(2):199-209
references: 15811483
references: AIDS. 2005 May 20;19(8):807-14
references: 15867495
references: AIDS Patient Care STDS. 2006 Jan;20(1):48-56
references: 16426156
references: AIDS. 2006 Jan 9;20(2):223-31
references: 16511415
references: Health Psychol. 2006 Jul;25(4):462-73
references: 16846321
references: Clin Infect Dis. 2006 Oct 1;43(7):942-4
references: 16941381
references: Niger J Med. 2006 Jul-Sep;15(3):222-6
references: 17111747
references: Sante. 2006 Apr-Jun;16(2):119-30
references: 17116636
references: J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S127-33
references: 17133196
references: J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S134-41
references: 17133197
references: J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S23-35
references: 17133201
references: AIDS Behav. 2007 Mar;11(2):161-73
references: 16804749
references: Antivir Ther. 2003 Dec;8(6):585-94
references: 14760892
references: Res Nurs Health. 2001 Dec;24(6):518-29
references: 11746080
references: Bull World Health Organ. 2001;79(12):1145-51
references: 11799447
references: Clin Infect Dis. 2002 Apr 15;34(8):1115-21
references: 11915001
references: Women Health. 2002;36(1):97-111
references: 12215006
references: J Gen Intern Med. 2002 Oct;17(10):756-65
references: 12390551
references: AIDS Patient Care STDS. 2002 Sep;16(9):431-9
references: 12396695
references: AIDS. 2002 Nov 8;16(16):2175-82
references: 12409739
references: Braz J Med Biol Res. 2002 Oct;35(10):1173-81
references: 12424490
references: Am J Addict. 2002 Fall;11(4):271-8
references: 12584870
references: AIDS Patient Care STDS. 2003 Jan;17(1):33-41
references: 12614518
references: HIV Clin Trials. 2003 Mar-Apr;4(2):121-31
references: 12671780
references: Health Psychol. 2003 Mar;22(2):223-8
references: 12683743
references: J Assoc Nurses AIDS Care. 2003 Mar-Apr;14(2):52-62
references: 12698766
references: AIDS. 2000 Mar 10;14(4):357-66
references: 10770537