Original Paper

AIDS and Behavior

, Volume 14, Issue 3, pp 721-730

First online:

Community-based DOT-HAART Accompaniment in an Urban Resource-Poor Setting

  • Maribel MuñozAffiliated withSocios En Salud Sucursal Perú
  • , Karen FinneganAffiliated withRollins School of Public Health, Emory University
  • , Jhon ZeladitaAffiliated withSocios En Salud Sucursal Perú
  • , Adolfo CaldasAffiliated withDivision of Global Health Equity, Brigham and Women’s Hospital
  • , Eduardo SanchezAffiliated withHospital Nacional Hipólito Unanue
  • , Miriam CallacnaAffiliated withHospital Nacional Hipólito Unanue
  • , Christian RojasAffiliated withHospital Nacional Hipólito Unanue
  • , Jorge ArevaloAffiliated withHospital Dos de Mayo
  • , Jose Luis SebastianAffiliated withPeruvian HIV Program, Ministerio de Salud
    • , Cesar BonillaAffiliated withPeruvian TB Program, Ministerio de Salud
    • , Jaime BayonaAffiliated withSocios En Salud Sucursal Perú
    • , Sonya ShinAffiliated withSocios En Salud Sucursal PerúDivision of Global Health Equity, Brigham and Women’s HospitalHarvard Medical School Email author 

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From December 2005 to April 2007, we enrolled 60 adults starting antiretroviral therapy (ART) in a health district of Lima, Peru to receive community-based accompaniment with supervised antiretroviral (CASA). Paid community health workers performed twice-daily home visits to directly observe ART and offered additional medical, social and economic support to CASA participants. We matched 60 controls from a neighboring district by age, CD4 and primary referral criteria (TB status, female, neither). Using validated instruments at baseline and 12 months (time of DOT-HAART completion) we measured depression, social support, quality of life, HIV-related stigma and self-efficacy. We compared 12 month clinical and psychosocial outcomes among CASA versus control groups. CASA participants experienced better clinical and psychosocial outcomes at 12 months, including proportion with virologic suppression, increase in social support and reduction in HIV-associated stigma.


Adherence HIV Resource-poor setting Poverty DOT-HAART