Comprehensive clinical adherence interventions to enable antiretroviral therapy: A case report
ABSTRACT Adherence to antiretroviral therapy is key for successful treatment of HIV-infected persons. To enhance adherence, multilevel interventions are necessary. This is often a challenge, as this case of an HIV-infected man with a history of poor adherence and multiple virological failures shows. With a multidisciplinary approach, comprehensive intervention strategies were used to facilitate the patient's adherence to an enfuvirtide-based regimen. The interventions are described in detail and include adherence support with modified daily observed therapy, support regarding symptom management, and social relationships. The patient's clinical progress was monitored using indicators such as clinical surrogate markers, adherence to antiretroviral therapy, and HIV-related symptom and depression scores. The case illustrates how interventions that were individualized, culturally sensitive, and provided by a team of health care providers enabled a patient to optimize his adherence, which led to significant improvement in his clinical surrogate markers and subjective quality of life.
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ABSTRACT: Directly observed therapy of highly active antiretroviral therapy (DOT-HAART) is a feasible adherence intervention. Prospective DOT-HAART studies have shown mixed results, and optimal target groups have yet to be defined. We performed a meta-analysis and systematic review to assess the effect of DOT-HAART on adherence and virologic and immunologic response. We performed a comprehensive search through August 2009 to identify peer-reviewed controlled studies that involved outpatient DOT-HAART among adults and reported at least 1 outcome assessed in this meta-analysis. Random-effects meta-analyses were performed; differences in effect on virologic suppression were examined using stratified meta-analyses and meta-regression on several study characteristics. Seventeen studies met inclusion criteria. Compared with control groups, DOT-HAART recipients were more likely to achieve an undetectable viral load (random effects risk ratio 1.24, 95% confidence interval (CI): 1.08 to 1.41), a greater increase in CD4 cell count (random effects weighted mean difference 43 cells/microL, 95% CI: 12 to 74 cells/microL), and HAART adherence of > or =95% (random effects risk ratio 1.17, 95% CI: 1.03 to 1.32). Results varied with respect to virologic response. DOT-HAART did not have a significant effect on virologic suppression when restricted to randomized controlled studies. Post-treatment effect was not observed in a limited number of studies. DOT-HAART had a significant effect on virologic, immunologic, and adherence outcomes, although its efficacy was not supported when restricting analysis to randomized controlled trials. DOT-HAART shows greatest treatment effect when targeting individuals with greater risk of nonadherence and when delivering the intervention that maximizes participant convenience and provides enhanced adherence support. Further investigation is needed to assess the postintervention effect and cost-effectiveness of DOT-HAART.JAIDS Journal of Acquired Immune Deficiency Syndromes 04/2010; 54(2):167-79. DOI:10.1097/QAI.0b013e3181d9a330 · 4.39 Impact Factor
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ABSTRACT: Poorly managed healthcare can be directly attributed to extensive drug regimens. Numerous chronic illnesses and epidemics such as HIV/AIDS and tuberculosis require elaborate drug regimens for efficacious therapeutic outcomes. Various drug delivery systems have been developed to simplify their regimental drug therapy. However, more effective and innovative drug delivery technologies are required to increase patient compliance and provide controlled drug delivery. This review article attempts to provide a concise incursion into the use of fixed dose combinations as a strategy for drug delivery and describes the opportunities and challenges for the treatment of conditions that require chronic suppressive regimental drug therapy.International Journal of Biotechnology 11/2010; 11. DOI:10.1504/IJBT.2010.036601
JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2011; 56(1):e33-4. DOI:10.1097/QAI.0b013e3181fcbcb4 · 4.39 Impact Factor