Preliminary findings of an intervention integrating modified directly observed therapy and risk reduction counseling

Midwest AIDS Training & Education Center, Jane Addams College of Social Work, University of Illinois at Chicago, IL 60607, USA.
AIDS Care (Impact Factor: 1.6). 05/2007; 19(4):561-4. DOI: 10.1080/09540120601040813
Source: PubMed


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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    • "Because these same goals apply to antiretroviral therapy, DOT programs have been extended to HIV treatment and often target HIV-infected drug users. Pilot studies have demonstrated the feasibility and acceptability of DOT programs for HIV treatment in settings such as community locations (Altice et al., 2004; Jayaweera et al., 2004; Ma et al., 2008; Macalino et al., 2004; Mitchell et al., 2007; Wohl et al., 2004), public HIV clinics or shelters (Garland et al., 2007; Tinoco et al., 2004), prisons (Babudieri, Aceti, D'Offizi, Carbonara, & Starnini, 2000), and methadone maintenance clinics (Clarke, Keenan, Ryan, Barry, & Mulcahy, 2002; Lucas, Weidle, Hader, & Moore, 2004; McCance-Katz et al., 2002). "
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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.
    Full-text · Article · Jan 2011 · Substance Use & Misuse
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    • "A literature review using search terms 'DAART' or 'DOT' or ' 'm-DOT' and 'HIV stigma' or 'perceived stigma' or 'internalised stigma' or 'attitude' of the period 1980-2009 identified articles on the effect of DOT on study participants' (mainly drug users) adherence, viral loads, CD4 cell counts and drug resistance (Macalino et al., 2007; Mitchell et al., 2007; Pearson et al., 2007). Two cross-sectional studies [in South Africa: (Page-Shipp et al., 2007); in the US: Santos et al., 2006)] focused on attitudes to directly-observed ART. "
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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.
    Full-text · Article · Aug 2010 · SAHARA J: journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council
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    ABSTRACT: Modified directly observed therapy (mDOT), in which a portion of total doses of a medication regime is ingested under supervision, has demonstrated efficacy as an intervention to assist patients in maintaining adherence to complicated antiretroviral therapy (ART). Although findings are favorable, existing efficacy studies fail to provide sufficient detail to guide others who wish to implement mDOT interventions. The aim of this article is to provide a primer for practitioners and researchers who wish to implement mDOT interventions. Drawing on the experience of 10 federally funded research projects, we provide guidance on critical questions for program implementation, including: who should be targeted, length/duration/content/location/tapering of sessions, staffing, incentives, and approaches to data collection. In addition, guidance on staff training and minimum requirements for mDOT interventions is offered along with real-world examples of mDOT interventions. mDOT is feasible and easily adapted to many settings and target populations. Interventions should match the specific needs of the target population and setting and be flexible in terms of design and delivery. mDOT should be considered among the spectrum of adherence interventions.
    Full-text · Article · Jul 2007 · Public Health Reports
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