The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #67966

Grace E Macalino, PhD¹, Jennifer A. Mitty, MD, MPH², Lauri B. Bazerman, MS², S. Michelle McKenzie, MPH³, and Timothy P. Flanigan, MD². (1) Brown University, 169 Angell St., Box GS-2, Providence, RI 02912, 401-863-9938, Grace_Macalino@Brown.edu, (2) Division of Immunology, The Miriam Hospital/Brown University School of Medicine, 164 Summit Avenue, Providence, RI 02906, (3) Division of Immunology, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906

Background: Highly active antiretroviral therapy (HAART) can dramatically decrease HIV plasma viral load (PVL), increase CD4+ cell counts, and prolong life for HIV-seropositive individuals; however, the need for optimal adherence has been recognized. We implemented a pilot community-based program of directly observed therapy (DOT) for HAART among individuals with substance use issues. Methods: Participants were put on once-daily HAART regimens prescribed by their primary care providers. A near-peer outreach worker delivered and observed doses 7/7 days for up to 6 months. Participants were assessed at baseline, 1, 3, and every 3 months thereafter until 12 months by a brief questionnaire, CD4+ cell count, and HIV PVL. Results: From December 1999 to January 2001, 25 HIV-seropositive individuals were enrolled and followed for a mean of 6.6 months (3.9 SD). Most participants achieved viral load suppression. All participants on the program for >6 months (n=13) felt the ORW helped them take their medications; only one individual felt the visits were an invasion of privacy. Over half of the participants that reported recently injecting heroin (5/9) or using crack (8/12) at baseline, did not use at the end of their follow-up period. Five of 10 participants that had not shared their HIV status with their family at baseline, as well as 2 of 3 that had not told friends, had disclosed their status by the 3-month follow-up visit. Discussion: Data indicate that indirect benefits of DOT may include a decrease in substance use and an increase in disclosure to family and friends.

Learning Objectives:

At the conclusion of this session, the participant will be able to:
• Describe a program that provides Directly Observed Therapy (DOT) for HAART, and
• identify possible direct clinical benefits and indirect psychosocial benefits of DOT.

Keywords: HIV/AIDS, HIV Interventions

Presenting author's disclosure statement:
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.