Initiation, Adherence, and Retention in a Randomized Controlled Trial of Directly Administered Antiretroviral Therapy

Directly administered antiretroviral therapy (DAART) can improve health outcomes among HIV-infected drug users. An understanding of the utilization of DAART—initiation, adherence, and retention—is critical to successful program design. Here, we use the Behavioral Model to assess the enabling, predis...

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Bibliographic Details
Published in:AIDS and behavior 2008-03, Vol.12 (2), p.284-293
Main Authors: Maru, Duncan Smith-Rohrberg, Bruce, R. Douglas, Walton, Mary, Mezger, Jo Anne, Springer, Sandra A., Shield, David, Altice, Frederick L.
Format: Article
Language:English
Subjects:
Acquired Immune Deficiency Syndrome
Addictive behaviors
AIDS
Anti-HIV Agents - adverse effects
Antiretroviral Therapy, Highly Active
Behavior
Case management
Clinical trials
Directly Observed Therapy - methods
Drug abuse
Drug resistance
Drug therapy
Guideline Adherence
Health Psychology
Health Services - utilization
Hispanic Americans
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV-1 - drug effects
HIV-1 - genetics
Human immunodeficiency virus
Humans
Imprisonment
Infectious Diseases
Low income groups
Medicine
Medicine & Public Health
Methadone
Original Paper
Patient Compliance - statistics & numerical data
Public Health
Retention
Retention (Psychology) - drug effects
Self Administration - methods
Social services
Substance-Related Disorders - complications
Treatment Methods
Treatment Outcome
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Summary:Directly administered antiretroviral therapy (DAART) can improve health outcomes among HIV-infected drug users. An understanding of the utilization of DAART—initiation, adherence, and retention—is critical to successful program design. Here, we use the Behavioral Model to assess the enabling, predisposing, and need factors impacting adherence in our randomized, controlled trial of DAART versus self-administered therapy (SAT) among 141 HIV-infected drug users. Of 88 participants randomized to DAART, 74 (84%) initiated treatment, and 51 (69%) of those who initiated were retained in the program throughout the entire six-month period. Mean adherence to directly observed visits was 73%, and the mean overall composite adherence score was 77%. These results were seen despite the finding that 75% of participants indicated that they would prefer to take their own medications. Major causes of DAART discontinuation included hospitalization, incarceration, and entry into drug-treatment programs. The presence of depression and the lack of willingness to travel greater than four blocks to receive DAART predicted time-to-discontinuation.
ISSN:1090-7165
1573-3254
DOI:10.1007/s10461-007-9336-2