title: Direct monthly highly active antiretroviral therapy supply - a method to increase patient's adherence and outcome. Experience of one AIDS centre in Israel.
abstract: In Israel, antiretroviral therapy (ART) is available (at local pharmacies) without cost. Nevertheless, poor adherence, especially of immigrants from Africa, leads to a high rate of treatment failures. Our study looked whether direct monthly ART supply in our AIDS centre has an effect on adherence and outcome. A total of 385 HIV (clade C) immigrants from Africa that were treated with ART for >2 years prior to the initiation of the study were evaluated. During the first 2 years, ART medications were supplied by local pharmacies. Thereafter (next 2 years), all patients received medications, monthly at our centre. Adherence, immunological (CD4) and virological (VL) outcome at the end of the two study periods were determined. At baseline, only 75% of the patients attended more than 90% of scheduled visits with 57% treatment adherence. Virological failure (VL >40 copies/ml) was observed in 53% of the patients. As a result of our intervention (2 years of direct monthly ART supply), visits and treatment adherence significantly increased (90% and 84%, respectively;p < 0.001). Concomitantly, virological failure rate significantly dropped to 28% (p < 0.001). Direct monthly supply of ART is a relatively low-cost mode to improve patient's adherence and immunological/virological outcomes.
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel.
authors.forename: Daniel
authors.initials: D
authors.lastname: Elbirt
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Asher
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel.
authors.forename: Keren
authors.initials: K
authors.lastname: Mahlev-Guri
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel.
authors.forename: Shira
authors.initials: S
authors.lastname: Bezalel-Rozenberg
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel.
authors.forename: Ben
authors.initials: B
authors.lastname: Werner
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel.
authors.forename: Yafa
authors.initials: Y
authors.lastname: Cohen
authors.affiliation: Clinical Immunology, Allergy and AIDS Center Kaplan Medical Center, Affiliated with Hadassah-Hebrew University Medical School Jerusalem, Rehovot, Israel Zev_S@clalit.org.il.
authors.forename: Zev
authors.initials: Z
authors.lastname: Sthoeger
mesh_terms: D000349:Africa / Q000208:ethnology; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000600:supply & distribution* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care / Q000379:methods; D023801:Directly Observed Therapy; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D015497:HIV-1; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents
keywords: Ethiopian; HIV/AIDS; adherence; clade C; direct observed therapy; highly active antiretroviral therapy