Initiation, adherence, and retention in a randomized controlled trial of directly administered antiretroviral therapy

AIDS Behav. 2008 Mar;12(2):284-93. doi: 10.1007/s10461-007-9336-2. Epub 2007 Dec 18.

Abstract

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Anti-HIV Agents / adverse effects*
  • Antiretroviral Therapy, Highly Active
  • Directly Observed Therapy* / methods
  • Guideline Adherence*
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV-1 / drug effects
  • HIV-1 / genetics
  • Health Services / statistics & numerical data
  • Humans
  • Patient Compliance / statistics & numerical data
  • Retention, Psychology / drug effects*
  • Self Administration / methods
  • Substance-Related Disorders / complications*
  • Treatment Outcome

Substances

  • Anti-HIV Agents