[WePeB5868] Sustained antiretroviral adherence following a short-term directly observed therapy intervention: The S.T.A.R.T. Program

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Sustained antiretroviral adherence following a short-term directly observed therapy intervention: The S.T.A.R.T. Program

[AUTHOR(S):] J Myers, C Farthing, J C Ricaurte, P T Korthuis¹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. WePeB5868

BACKGROUND: Management of HIV-infected persons non-adherent to antiretroviral therapy (ARV) is a challenging aspect of HIV care. Many have barriers rendering them refractory to usual adherence tools. We developed a directly observed therapy (DOT) inpatient intervention to facilitate adherence for persons with refractory non-adherence.

METHODS: Success Through Anti-Retroviral Therapy (START) is a DOT intervention organized by AIDS Healthcare Foundation. Providers refer participants for non-adherence on the basis of provider/patient assessment, repeated hospitalizations, failure of viral suppression, and prior attempts to improve adherence. Participants are admitted to a skilled nursing facility for 4-6 weeks where community volunteers, social workers, and medical staff supervise DOT, HIV education, and psychosocial support groups designed to address individual barriers to adherence. Adherence is assessed periodically after discharge by viral load PCR(VL) and patient/provider report. We assessed univariate associations adherence using Chi-square and t-tests(a=.05).

RESULTS: 104 START participants(mean age 40 yrs, 10% female) were followed for a mean of 24(stdv=11) months after discharge. 90% had AIDS. 11 participants died and 20 were lost to follow-up. Of the remaining 85 participants, 75% maintained adherence to ARV as reported by both patient and provider and confirmed by suppressed VL. 19% achieved sustained VL<50 copies and 40% maintained VL<1000 copies. Of 21(25%) who did not sustain adherence, failure was attributed to relapse of substance abuse or psychiatric disease exacerbation. Adherence did not vary by race, age, gender, or risk group.

CONCLUSIONS: START achieved sustained adherence in 75% and viral suppression in 40% of previously non-adherent participants with advanced HIV disease. Short-term inpatient DOT interventions may facilitate long-term adherence and viral suppression in patients with refractory non-adherence.

Presenting author: C Farthing

1AIDS Healthcare Foundation, Los Angeles, CA, United States

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