 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Vijayabhaskar Reddy Kandula, MD MPH, Homayoun khanlou, MD, and Charles Farthing, MD. Research, AIDS Healthcare Foundation, 1300 N. Vermont Ave, Suite 606, Los Angeles, CA 90027, 323.766.2326, emailreddy@yahoo.com
Background: Highly Active Anti-Retroviral Therapy (HAART) has reduced AIDS mortality. However, non-adherence to HAART remains a major challenge and is the strongest predictor of virological failure and development of resistance. Directly Observed Therapy (DOT) has been proposed as a novel strategy to address adherence.
Methods: Review of current literature.
Discussion: DOT has been proposed as a strategy to improve adherence to HAART. Newer anti-retrovirals allow once-a-day dosing making DOT feasible. DOT has shown to be effective in substance abuse treatment programs and in incarcerated patients. It has been beneficial in delivering HAART even in resource poor settings such as Haiti. DOT for as short as four to eight days has been effective. HAART therapy is life long, therefore the duration and setting for DOT has to be planned according to available resources and patient characteristics: longer in prison and clinic settings and shorter in case of skilled nursing facilities or other in-patient facilities. Often, non-adherence recurs and the benefits of DOT wear off. Intermittent DOT of shorter durations at regular intervals of six to twelve months could be considered to maintain the benefits. Innovative approaches are needed to explore its usefulness in different settings. The intervention seems costly but is effective and is justified from a public health perspective for certain recalcitrant patients. Cost effectiveness studies are urgently needed. Literature and data on DOT for HIV will be presented.
Learning Objectives:
Keywords: Adherence, Antiretroviral Combination Therapy
Related Web page: www.aidshealth.org
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.