Journal Article

Directly Administered Antiretroviral Therapy in an Urban Methadone Maintenance Clinic: A Nonrandomized Comparative Study

Gregory M. Lucas, Paul J. Weidle, Shannon Hader and Richard D. Moore

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue Supplement_5, pages S409-S413
Published in print June 2004 | ISSN: 1058-4838
Published online June 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/421405
Directly Administered Antiretroviral Therapy in an Urban Methadone Maintenance Clinic: A Nonrandomized Comparative Study

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Methadone-maintenance treatment clinics are strategically appealing sites for provision of directly administered antiretroviral therapy (DAART) to human immunodeficiency virus type 1 (HIV-1)—infected injection drug users (IDUs). We initiated an ongoing DAART protocol at a university-associated methadone clinic in April 2001, which continues to enroll participants. Participants ingested antiretroviral medications under direct supervision on days they attended the clinic; evening doses and doses on “methadone take-home days” were self-administered. Comparison IDUs receiving either standard care or treatment-adherence support were randomly selected from the population of the HIV-1 clinic where DAART participants received their primary care for HIV-1 infection, with frequency matching by sex, prior antiretroviral exposure, and receipt of methadone therapy. In an intention-to-treat analysis, 79% of DAART participants achieved HIV-1 RNA levels of <400 copies/mL by month 6 of therapy, compared with 54% in the standard care group (P = .035) and 48% in the adherence support group (P = .008). The preliminary results of this study both suggest that DAART can be feasible and acceptable to patients in a methadone clinic setting and provide impetus for further study of this treatment strategy in randomized controlled trials.

Journal Article.  2618 words.  Illustrated.

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

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