Directly administered antiretroviral therapy: pilot study of a structural intervention in methadone maintenance.
- Author(s): Sorensen, James L;
- Haug, Nancy A;
- Larios, Sandra;
- Gruber, Valerie A;
- Tulsky, Jacqueline;
- Powelson, Elisabeth;
- Logan, Deborah P;
- Shapiro, Bradley
- et al.
Published Web Locationhttps://doi.org/10.1016/j.jsat.2012.08.014
Devising interventions to provide integrated treatment for addiction and medical problems is an urgent issue. This study piloted a structural intervention, Directly Administered Antiretroviral Therapy (DAART), to assist methadone-maintenance patients in HIV medication adherence. Twenty-four participants received: (1) antiretroviral medications at the methadone clinic daily before receiving their methadone; (2) take-home antiretroviral medication for days they were not scheduled to attend the methadone clinic, and (3) brief adherence counseling to address adherence barriers. DAART lasted 24 weeks, with a planned step-down to twice-weekly administration in weeks 25-36, followed by self-administration in weeks 37-48. Retention rates at weeks 24, 36, and 48 were 83, 92, and 75% respectively. DAART was associated with improvement in the proportion of participants achieving viral suppression as well as with high medication adherence rates (clinic-verified; 85% and self-reported 97%) during the active intervention phase. DAART was effective as an intervention but did not promote transition to self-administration. This study demonstrates that DAART is adaptable and simple enough to be implemented into methadone treatment programs interested in providing HIV adherence services.