4040.0: Tuesday, November 14, 2000 - 9:30 AM

Abstract #11115

A pilot intervention to enhance adherence to HIV medication therapies: Lessons learned

S. Michelle McKenzie, MPH1, Molly S. Stenzel, MD1, Jennifer Adelson-Mitty, MD, MPH2, and Timothy P. Flanigan, MD1. (1) Division of Immunology, The Miriam Hospital/Brown University, 164 Summit Avenue, 3rd Floor Fain Building, Providence, RI 02906, 401/793-4790, mmckenzie@lifespan.org, (2) Beth Israel-Deaconess Medical Center/Harvard University

Background: Though highly active antiretroviral therapy (HAART) increases the therapeutic options of HIV infected persons, strict adherence is essential for successful outcomes. In 6/98 we began an intensive adherence intervention of modified directly observed therapy (MDOT) among patients who self-report non-adherence to HAART. Methods: Outreach workers deliver pre-packed medications from one to five days per week. New participants receive five visits per week, after six months visits are tapered to once weekly. During each visit one dose is observed, additional doses are left with the patient to self-administer, and adherence to unobserved doses is recorded. Results: Thirty-seven individuals enrolled in MDOT. At baseline the mean age was 38 years, 65% female, 24% white, 31% black and 38% Latino, 68% had been in jail at least once and 45% reported active substance abuse. Eighteen participants completed 12 months on the program; 16 dropped out prior to program completion; 3 continue active participation. Final project evaluations (n=17) indicated participant satisfaction. All the participants felt the outreach worker helped them take their medications; 71% felt better about taking medications; and there was a mean reduction in plasma viral load of 1.7 log10. Transitioning participants to independent medication adherence, medication holidays, consequences of attachment/dependence on outreach staff, cyclical patterns of appointment keeping with outreach staff, and staff support/burnout were critical issues. Conclusions: MDOT is an acceptable and feasible intervention to enhance adherence to HAART. Future research is needed to explore the role of DOT of once-daily HAART regimens and who most benefits from these interventions.

Learning Objectives: (1) To describe the various components of the modified directly observed therapy (MDOT) study. (2) To discuss the results of the intervention and its relevance in HIV medication adherence strategies. (3) To identify the problems and successes of implementing this intensive, outreach worker based project

Keywords: Adherence, HIV/AIDS

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA