Preliminary findings of an intervention integrating modified directly observed therapy and risk reduction counseling.
ABSTRACT Various interventions have been proposed to address these ongoing needs of HIV-positive patients as they encounter challenges with medication adherence and risk reduction. This report presents the findings of a study that pilots 'DAART+', an intervention that integrates modified directly observed therapy (MDOT), and risk reduction counseling for a population of marginally housed, substance-using persons. The pilot study intended to assess the feasibility of the intervention and to obtain data to assess the intervention's potential effectiveness. The preliminary data reveal that 83% of participants who completed the intervention (n=18) had undetectable viral load (VL) (VL< or =400 copies/mL) which represents a 2.15 log(10) decrease from baseline. Risk behaviors also changed modestly with self-reported increases in condom usage.
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ABSTRACT: We review five innovative strategies to improve access, utilization, and adherence for HIV-infected drug users and suggest areas that need further attention. In addition, we highlight two innovative programs. The first increases access and utilization through integrated HIV and opioid addiction treatment with buprenorphine in a community health center, and the second incorporates adherence counseling for antiretroviral therapy in methadone programs. Preliminary evaluations demonstrated that these strategies may improve both HIV and opioid addiction outcomes and may be appropriate for wider dissemination. Further refinement and expansion of strategies to improve outcomes of HIV-infected drug users is warranted.Substance Use & Misuse 01/2011; 46(2-3):218-32. DOI:10.3109/10826084.2011.522840 · 1.23 Impact Factor
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ABSTRACT: HIV and AIDS remain highly stigmatised. Modified directly observed therapy (m-DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health centre-based m-DOT strategy with standard self-administration of ART. Data on perceived stigma were collected using Berger's HIV stigma scale prior to starting ART and after 12 months. This was a secondary analysis to examine whether perceived stigma was related to treatment delivery. Perceived stigma scores declined after 12 months of treatment from a mean of 44.9 (sd=7.6) to a mean of 41.4 (sd=7.7), (t=6.14, P<0.001). No differences were found between the mean scores of participants in both study arms. Also, no difference in scores was detected using GLM, controlling for socio-demographic characteristics and baseline scores. Findings indicate that a well managed clinic-based m-DOT does not increase perceived HIV-related stigma.SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council 08/2010; 7(2):62-70. DOI:10.1080/17290376.2010.9724958 · 0.81 Impact Factor
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ABSTRACT: The present study measures levels of stigma within health care settings in urban and rural Gujarat, in an attempt to understand how this may have contributed to the state's increasing HIV incidence. Two sites were studied: a rural hospital in Bardoli and an urban hospital in Surat. HIV-associated stigma among healthcare workers (N=170) was assessed using a Stigma Index. Overall, analyses suggest an increase in medical education was found to be associated with higher stigmatisation (p<0.001). Furthermore, a statistically significant difference between stigma scores of HCWs in rural and urban Gujarat was not observed.SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council 08/2010; 7(2):71-5. DOI:10.1080/17290376.2010.9724959 · 0.81 Impact Factor