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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
3072.0: Monday, December 12, 2005 - Board 5

Abstract #111379

Improving adherence to highly active anti-retroviral therapy using directly observed therapy administered by community health workers

Sasha Kohnowich1, Jose Sostre1, Karen Peugh1, Barbara Uhrie1, Michael Abele, MD2, Samantha Bessega, MD2, Krishnamoorthy Rao, MD2, Dorcas Grigg-Saito, MS3, Denise Sanderson1, and Scott Record1. (1) HIV Department, Lowell Community Health Center, 585 Merrimack St., Lowell, MA 01854, 978-937-9700, joseso@lchealth.org, (2) Adult Medicine, Lowell Community Health Center, 585 Merrimack St., Lowell, MA 01854, (3) Lowell Community Health Center, 585 Merrimack Street, Lowell, MA 01854

Our agency recognized that on-site treatment adherence support was insufficient for some clients living with HIV/AIDS. We implemented directly observed therapy (DOT) to provide more intensive outreach to these clients. A community health worker (CHW) oversees patients' daily dosing at home. We hire HIV-positive CHWs, providing mutually beneficial peer interaction.

Our DOT pilot began in August 2004 and has been largely successful. Five clients had received services for at least one month as of January 28, 2005. The average period of enrollment was 13 weeks. All five clients reported satisfaction with the service. The data show commitment to the program and ameliorated follow-up. The mean percentage of DOT attendance was 88% and average attendance for clinic appointments had increased from 61% to 86%. Client lab values had also improved. Four clients were not on HAART before DOT due to past difficulties with adherence. These individuals' absolute CD4+ values averaged 97 L/uL at baseline. After approximately seven weeks of HAART-DOT, clients' CD4+ values increased to an average of 134 L/uL and viral load values dropped by 1.6 logs. One client was on anti-retroviral treatment before starting DOT. His CD4+ was 220 L/uL and his viral load was 202,815. After seven weeks on DOT, his CD4+ remained stable and his viral load decreased to 2081 (a 2.0 log change).

Our results indicate that CHWs can function as effective DOT providers for HIV-positive peers. We believe that CHW-directed DOT may improve treatment outcomes in clients for whom standard adherence interventions have failed.

Learning Objectives:

Keywords: HIV Interventions, Adherence

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

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The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA