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Effect of Directly Observed Antiretroviral Therapy Compared to Self-Administered Antiretroviral Therapy on Adherence and Virological Outcomes among HIV-Infected Prisoners: A Randomized Controlled Pilot Study.
- Source :
- AIDS & Behavior; Jan2015, Vol. 19 Issue 1, p128-136, 9p
- Publication Year :
- 2015
-
Abstract
- The effect of directly observed therapy (DOT) versus self-administered therapy (SAT) on antiretroviral (ART) adherence and virological outcomes in prison has never been assessed in a randomized, controlled trial. Prisoners were randomized to receive ART by DOT or SAT. The primary outcome was medication adherence [percent of ART doses measured by the medication event monitoring system (MEMS) and pill counts] at the end of 24 weeks. The changes in the plasma viral loads from baseline and proportion of participants virological suppressed (<400 copies/mL) at the end of 24 weeks were assessed. Sixty-six percent (90/136) of eligible prisoners declined participation. Participants in the DOT arm ( n = 20) had higher viral loads than participants in the SAT ( n = 23) arm ( p = 0.23). Participants, with complete data at 24 weeks, were analyzed as randomized. There were no significant differences in median ART adherence between the DOT ( n = 16, 99% MEMS [IQR 93.9, 100], 97.1 % pill count [IQR 95.1, 99.3]) and SAT ( n = 21, 98.3 % MEMS [IQR 96.0, 100], 98.5 % pill count [95.8, 100]) arms ( p = 0.82 MEMS, p = 0.40 Pill Count) at 24 weeks. Participants in the DOT arm had a greater reduction in viral load of approximately −1 log 10 copies/mL [IQR −1.75, −0.05] compared to −0.05 [IQR −0.45, 0.51] in the SAT arm ( p value = 0.02) at 24 weeks. The proportion of participants achieving virological suppression in the DOT vs SAT arms was not statistically different at 24 weeks (53 % vs 32 %, p = 0.21). These findings suggest that DOT ART programs in prison settings may not offer any additional benefit on adherence than SAT programs. [ABSTRACT FROM AUTHOR]
- Subjects :
- COMPARATIVE studies
HIV-positive persons
PRISONERS
RESEARCH funding
STATISTICAL sampling
SELF medication
STATISTICS
T-test (Statistics)
PILOT projects
DATA analysis
RANDOMIZED controlled trials
HIGHLY active antiretroviral therapy
TREATMENT effectiveness
DATA analysis software
DESCRIPTIVE statistics
KARNOFSKY Performance Status
DIRECTLY observed therapy
Subjects
Details
- Language :
- English
- ISSN :
- 10907165
- Volume :
- 19
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- AIDS & Behavior
- Publication Type :
- Academic Journal
- Accession number :
- 100549755
- Full Text :
- https://doi.org/10.1007/s10461-014-0850-8