The Feasibility of Modified Directly Observed Therapy for HIV-Seropositive African American Substance Users
Nova Southeastern University, Fort Lauderdale, Florida, USA. AIDS patient care and STDs
(Impact Factor: 3.5).
03/2008; 22(2):139-46. DOI: 10.1089/apc.2007.0063
Recently, modified directly observed therapy (MDOT) has emerged as a promising intervention to address nonadherence for hard-to-reach populations infected with HIV. To date, there are no existing data on MDOT focusing exclusively on African Americans. The present study sought to determine the feasibility of MDOT among 31 HIV-seropositive African American substance users in the South. An outreach worker observed the participants' medication intake 5 days per week (once per day) for a period of 3 months (intensive phase). This phase was followed by a transition phase of 3 months during which the frequency of MDOT was gradually tapered from 5 days to once weekly. Assessments to gather demographic information, HIV risk behaviors, substance use, depression, and medication adherence were conducted at baseline, 3 months, and 6 months. Results indicated that more participants adhered to their medication regimen and had viral loads of less than 400 copies per milliliter at 3 and 6 months compared to baseline. Participants reported significantly less depressive symptoms at the 6-month assessment compared to baseline and 3 months. With regard to acceptability, 95% of participants indicated they liked having the outreach visits, 100% reported MDOT helped them take their medications, and only 5% felt MDOT was a violation of privacy. These results suggest MDOT is feasible among African American substance users in the South and a larger controlled study of MDOT with this population is warranted.
Available from: Julia H Arnsten
- "In fact, among TAU participants with undetectable baseline VL, 21% experienced viral rebound. While several DOT studies have reported decreases in VL (Altice et al., 2007; Conway et al., 2004; Lucas et al., 2006; Macalino et al., 2007) and modest improvements in self-reported adherence (Altice et al., 2007; MA et al., 2008; Pearson et al., 2007), ours is one of the few DOT trials to report improvements in objectively measured adherence at multiple time points. "
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ABSTRACT: To determine if directly observed antiretroviral therapy (DOT) is more efficacious than self-administered therapy for improving adherence and reducing HIV viral load (VL) among methadone-maintained opioid users.
Two-group randomized trial.
Twelve methadone maintenance clinics with on-site HIV care in the Bronx, New York.
HIV-infected adults prescribed combination antiretroviral therapy.
Between group differences at four assessment points from baseline to week 24 in: (1) antiretroviral adherence measured by pill count, (2) VL, and (3) proportion with undetectable VL (< 75 copies/ml).
Between June 2004 and August 2007, we enrolled 77 participants. Adherence in the DOT group was higher than in the control group at all post-baseline assessment points; by week 24 mean DOT adherence was 86% compared to 56% in the control group (p < 0.0001). Group differences in mean adherence remained significant after stratifying by baseline VL (detectable versus undetectable). In addition, during the 24-week intervention, the proportion of DOT participants with undetectable VL increased from 51% to 71%.
Among HIV-infected opioid users, antiretroviral DOT administered in methadone clinics was efficacious for improving adherence and decreasing VL, and these improvements were maintained over a 24-week period. DOT should be more widely available to methadone patients.
Available from: Chinazo O Cunningham
- "Another study found that in an intensive case management program that used outreach to link ex-offenders into HIV care, 82% of ex-offenders continued to receive HIV care at 1 year (Rich et al., 2001). Finally, as described below, several programs providing directly observed antiretroviral therapy through community outreach demonstrate improved adherence and virologic outcomes among drug users (Altice et al., 2004; Jayaweera et al., 2004; Ma et al., 2008; Macalino et al., 2004; Mitchell, Freels, Creticos, Oltean, & Douglas, 2007; Wohl et al., 2004). "
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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.
Available from: An-Lin Cheng
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ABSTRACT: This paper outlines the development and initial testing of the READY intervention that was designed to enhance readiness for adherence among adults with a history of nonadherence to HIV treatment. Participants in this study were adults (n = 28) who ranged in age from 24 to 57: most were male (75%) and African American (64%). Participants had failed an average of four prior HIV treatment regimens due to nonadherence and were beginning a new regimen of protease inhibitor (PI)-based antiretroviral medications. The study was conducted from 2003 to 2006, prior to the standard use of boosted PI regimens. Results indicated that 50% of participants became adherent and had suppressed viral loads to less than 50 copies per milliliter at the 3-month postintervention follow-up time point. Of those who became adherent, 79% remained adherent at the 12-month postintervention follow-up time point. Implementation of the intervention was found to be feasible in a real-world setting and participants reported that they liked the intervention. A 6-session length of the intervention was found to have the same impact on adherence outcomes as a 12-session length. No differences were found in outcomes with regard to the intervention's start time: before or at the same time the new antiretroviral regimen was initiated. These results suggest that the READY intervention may have merit and that the 6-session length may be more acceptable. However, a larger controlled study is indicated to examine intervention efficacy further.
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