14th International AIDS Conference


Barcelona, Spain — July 7-12, 2002

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[TITLE:] Direct observed therapy (DOT) in HIV is it a feasible in clinical practice? Problems associated with DOT an amprenavir containing HAART regimen in an antiretroviral naïve, inner-city minority patients with poor HIV knowledge and very advanced AIDS

[AUTHOR(S):] D. Jayaweera, T. Tanner, R. Campo, A. Rodriquez, M. Kolber1, A.M. Nowak, M. Brill, J. Pottage2

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. TuPeE5208

ISSUES: DOT, although have been shown to be successful in incarcerated patients, it has not been tested in the community. While DOT is not an option for all patients infected with HIV it may be an option with inner-city minority patients with, multiple social problems, substance abuse and poor HIV specific knowledge. In this study we evaluated the practical difficulties associated with DOT in a community setting.

DESCRIPTION: Prospective, nonrandomized, pilot study in an inner city, hospital based clinic. Antiretroviral naïve patients were treated with Amprenavir 1200mg, Ritonavir 200mg, Videx EC 400mg and Epivir 300mg once a day. Patients had DOT and the non-compliant patients were removed from the study.

LESSONS LEARNED: Twenty eight patients were screened and 20 were enrolled. Three patients were lost to follow up within 1-2 weeks due to drug abuse and one never returned for the results and 3 did not meet the entry criteria. Problems associated with DOT during the study were as follows:

  1. Patients not available at DOT visits, with all patients 20/20 (100%). In some patients this was frequent. This may have resulted in treatment being delayed beyond 24 hours.
  2. Patients becoming homeless during the study, living in a shelter, 4/20 (20%).
  3. Patients losing the phone or other methods to contact 5/20 (25%).
  4. Drug abuse while on study 3/20 (15%).
  5. Family members unaware of the diagnosis 10/20 (50%).
  6. Patients going on vacation or going out of town, during the study or jail 4/20 (20%).
  7. Change in the work schedule or moving out of the area 3/20 (15%).
  8. Dangerous neighborhoods 3/20 (15%).
  9. Patients lack of understanding of HIV despite education and hence attempting to stop therapy as they are feeling well 8/20 (40%).

Recommendations: This suggests that despite DOT, barriers to treatment still exist with this challenging population. Further studies are needed using a different population.

Presenting author: Dushyantha Jayaweera

1Division of Infectious Diseases, University of Miami, Miami, FL, United States.

2Vertex Pharmaceuticals Incorporated, Cambridge, United States.

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Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.