Journal Article

Modified Directly Observed Therapy for the Treatment of HIV-Seropositive Substance Users: Lessons Learned from a Pilot Study

Grace E. Macalino, Jennifer A. Mitty, Lauri B. Bazerman, Kavita Singh, Michelle McKenzie and Timothy Flanigan

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue Supplement_5, pages S393-S397
Published in print June 2004 | ISSN: 1058-4838
Published online June 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/421402
Modified Directly Observed Therapy for the Treatment of HIV-Seropositive Substance Users: Lessons Learned from a Pilot Study

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Highly active antiretroviral therapy (HAART) can dramatically decrease human immunodeficiency virus (HIV) load in plasma, increase CD4+ cell counts, and prolong life for HIV-seropositive persons. However, the need for optimal adherence has been recognized. We implemented a pilot community-based program of directly observed therapy (DOT) with HAART among persons with substance use disorders and a history of failure of HAART. A near-peer outreach worker initially delivered and observed once-daily HAART doses on up to 7 days per week. Many participants tapered the frequency of visits. Participants were assessed by a brief questionnaire and determination of their CD4+ cell count and plasma HIV load. Twenty-five HIV-seropositive persons were enrolled and followed-up for a mean of 6.6 months (standard deviation, 3.9 months). We found that once-daily dosing of HAART by DOT is feasible in this population; in addition to observation of the majority of doses, most participants achieved virus suppression and felt favorably about the intervention. Tapering the intensity of visits with maximum flexibility was necessary to enhance the acceptability of the program to participants.

Journal Article.  2604 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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