title: Directly administered antiretroviral therapy: pilot study of a structural intervention in methadone maintenance.
abstract: Devising interventions to provide integrated treatment for addiction and medical problems is an urgent issue. This study piloted a structural intervention, Directly Administered Antiretroviral Therapy (DAART), to assist methadone-maintenance patients in HIV medication adherence. Twenty-four participants received: (1) antiretroviral medications at the methadone clinic daily before receiving their methadone; (2) take-home antiretroviral medication for days they were not scheduled to attend the methadone clinic, and (3) brief adherence counseling to address adherence barriers. DAART lasted 24 weeks, with a planned step-down to twice-weekly administration in weeks 25-36, followed by self-administration in weeks 37-48. Retention rates at weeks 24, 36, and 48 were 83, 92, and 75% respectively. DAART was associated with improvement in the proportion of participants achieving viral suppression as well as with high medication adherence rates (clinic-verified; 85% and self-reported 97%) during the active intervention phase. DAART was effective as an intervention but did not promote transition to self-administration. This study demonstrates that DAART is adaptable and simple enough to be implemented into methadone treatment programs interested in providing HIV adherence services.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, USA. james.sorensen@ucsf.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Sorensen
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Haug
authors.forename: Sandra
authors.initials: S
authors.lastname: Larios
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Gruber
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Tulsky
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Powelson
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Logan
authors.forename: Bradley
authors.initials: B
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated / Q000379:methods; D023801:Directly Observed Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D010865:Pilot Projects; D011614:Psychotherapy, Brief / Q000379:methods; D012646:Self Administration; D016320:Substance Abuse Treatment Centers / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents; D008691:Methadone