Initiation, adherence, and retention in a randomized controlled trial of directly administered antiretroviral therapy.
Directly administered antiretroviral therapy (DAART) can improve health outcomes among HIV-infected drug users. An understanding of the utilization of DAART-initiation, adherence, and retention-is critical to successful program design. Here, we use the Behavioral Model to assess the enabling, predisposing, and need factors impacting adherence in our randomized, controlled trial of DAART versus self-administered therapy (SAT) among 141 HIV-infected drug users. Of 88 participants randomized to DAART, 74 (84%) initiated treatment, and 51 (69%) of those who initiated were retained in the program throughout the entire six-month period. Mean adherence to directly observed visits was 73%, and the mean overall composite adherence score was 77%. These results were seen despite the finding that 75% of participants indicated that they would prefer to take their own medications. Major causes of DAART discontinuation included hospitalization, incarceration, and entry into drug-treatment programs. The presence of depression and the lack of willingness to travel greater than four blocks to receive DAART predicted time-to-discontinuation.
Maru
Duncan Smith-Rohrberg
DS
Yale University AIDS Program, 135 College Street, Suite 323, New Haven, CT 06510-2283, USA.
Bruce
R Douglas
RD
Walton
Mary
M
Mezger
Jo Anne
JA
Springer
Sandra A
SA
Shield
David
D
Altice
Frederick L
FL
D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active; D023801:Directly Observed Therapy / Q000379:methods; D019983:Guideline Adherence; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D010349:Patient Compliance / Q000706:statistics & numerical data; D012153:Retention, Psychology / Q000187:drug effects*; D012646:Self Administration / Q000379:methods; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
D019380:Anti-HIV Agents