Original Paper

AIDS and Behavior

, Volume 12, Issue 2, pp 284-293

Initiation, Adherence, and Retention in a Randomized Controlled Trial of Directly Administered Antiretroviral Therapy

  • Duncan Smith-Rohrberg MaruAffiliated withYale University AIDS Program
  • , R. Douglas BruceAffiliated withYale University AIDS Program
  • , Mary WaltonAffiliated withYale University AIDS Program
  • , Jo Anne MezgerAffiliated withYale University AIDS Program
  • , Sandra A. SpringerAffiliated withYale University AIDS Program
  • , David ShieldAffiliated withYale University AIDS Program
  • , Frederick L. AlticeAffiliated withYale University AIDS Program Email author 

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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.

Keywords

HIV Acquired immunodeficiency syndrome Substance abuse Directly administered antiretroviral therapy Adherence Directly observed therapy