AIDS and Behavior

, Volume 14, Issue 3, pp 721–730

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

  • Maribel Muñoz
  • Karen Finnegan
  • Jhon Zeladita
  • Adolfo Caldas
  • Eduardo Sanchez
  • Miriam Callacna
  • Christian Rojas
  • Jorge Arevalo
  • Jose Luis Sebastian
  • Cesar Bonilla
  • Jaime Bayona
  • Sonya Shin
Original Paper

Abstract

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.

Keywords

Adherence HIV Resource-poor setting Poverty DOT-HAART 

References

  1. Bangsberg, D. R., Hecht, F. M., Charlebois, E. D., Zolopa, A. R., Holodniy, M., Sheiner, L., et al. (2000). Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS (London, England), 14(4), 357–366. doi:10.1097/00002030-200003100-00008.Google Scholar
  2. Behforouz, H. L., Kalmus, A., Scherz, C. S., Kahn, J. S., Kadakia, M. B., & Farmer, P. E. (2004). Directly observed therapy for HIV antiretroviral therapy in an urban US setting. Journal of Acquired Immune Deficiency Syndromes, 36(1), 642–645. doi:10.1097/00126334-200405010-00016.CrossRefPubMedGoogle Scholar
  3. Berger, B. E., Ferrans, C. E., & Lashley, F. R. (2001). Measuring stigma in people with HIV: Psychometric assessment of the HIV stigma scale. Research in Nursing & Health, 24(6), 518–529. doi:10.1002/nur.10011.CrossRefGoogle Scholar
  4. Bisson, G. P., Gaolathe, T., Gross, R., Rollins, C., Bellamy, S., Mogorosi, M., et al. (2008). Overestimates of survival after HAART: Implications for global scale-up efforts. PLoS ONE, 3(3), e1725.CrossRefPubMedGoogle Scholar
  5. Bradley-Ewing, A., Thomson, D., Pinkston, M., & Goggin, K. J. (2008). A qualitative examination of the indirect effects of modified directly observed therapy on health behaviors other than adherence. AIDS Patient Care and STDs, 22(8), 663–668. doi:10.1089/apc.2007.0190.CrossRefPubMedGoogle Scholar
  6. Broadhead, W. E., Gehlbach, S. H., de Gruy, F. V., & Kaplan, B. H. (1988). The Duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Medical Care, 26(7), 709–723. doi:10.1097/00005650-198807000-00006.CrossRefPubMedGoogle Scholar
  7. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge: Harvard University Press.Google Scholar
  8. Bukusuba, J., Kikafunda, J. K., & Whitehead, R. G. (2007). Food security status in households of people living with HIV/AIDS (PLWHA) in a Ugandan urban setting. The British Journal of Nutrition, 98(1), 211–217. doi:10.1017/S0007114507691806.CrossRefPubMedGoogle Scholar
  9. Byakika-Tusiime, J., Oyugi, J. H., Tumwikirize, W. A., Katabira, E. T., Mugyenyi, P. N., & Bangsberg, D. R. (2003). Ability to purchase and secure stable therapy are significant predictors of non-adherence to antiretroviral therapy in Kampala, Uganda. Presented February 10–14, 2003 at the 10th Conference on Retroviruses and Opportunistic Infections (CROI), Boston, MA. Abstract #170 retrieved from http://www.retroconference.org/2003/cd/Abstract/170.htm.
  10. Castro, A. (2005). Adherence to antiretroviral therapy: Merging the clinical and social course of AIDS. PLoS Medicine, 2(12), e338. doi:10.1371/journal.pmed.0020338.CrossRefPubMedGoogle Scholar
  11. Castro, A., & Farmer, P. (2005). Understanding and addressing AIDS-related stigma: From anthropological theory to clinical practice in Haiti. American Journal of Public Health, 95(1), 53–59. doi:10.2105/AJPH.2003.028563.CrossRefPubMedGoogle Scholar
  12. Chen, S. C., Yu, J. K., Harries, A. D., Bong, C. N., Kolola-Dzimadzi, R., Tok, T. S., King, C. C., & Wang, J. D. (2008). Increased mortality of male adults with AIDS related to poor compliance to antiretroviral therapy in Malawi. Tropical Medicine & International Health. doi: 10.1111/j.1365-3165.2008.02029.x.
  13. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. Patient care committee & adherence working group of the outcomes committee of the adult AIDS clinical trials group (AACTG). AIDS Care, 12(3), 255–266. doi:10.1080/09540120050042891.CrossRefPubMedGoogle Scholar
  14. Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The hopkins symptom checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19(1), 1–15. doi:10.1002/bs.3830190102.CrossRefPubMedGoogle Scholar
  15. Farmer, P., Leandre, F., Mukherjee, J. S., Claude, M., Nevil, P., Smith-Fawzi, M. C., et al. (2001). Community-based approaches to HIV treatment in resource-poor settings. Lancet, 358(9279), 404–409. doi:10.1016/S0140-6736(01)05550-7.CrossRefPubMedGoogle Scholar
  16. Gill, C. J., Hamer, D. H., Simon, J. L., Thea, D. M., & Sabin, L. L. (2005). No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa. AIDS (London, England), 19(12), 1243–1249. doi:10.1097/01.aids.0000180094.04652.3b.Google Scholar
  17. Hardon, A. P., Akurut, D., Comoro, C., Ekezie, C., Irunde, H. F., Gerrits, T., et al. (2007). Hunger, waiting time and transport costs: Time to confront challenges to ART adherence in Africa. AIDS Care, 19(5), 658–665. doi:10.1080/09540120701244943.CrossRefPubMedGoogle Scholar
  18. Idoko, J. A., Agbaji, O., Agaba, P., Akolo, C., Inuwa, B., Hassan, Z., et al. (2007). Direct observation therapy-highly active antiretroviral therapy in a resource-limited setting: The use of community treatment support can be effective. International Journal of STD & AIDS, 18(11), 760–763. doi:10.1258/095646207782212252.CrossRefGoogle Scholar
  19. Kadiyala, S., & Gillespie, S. (2004). Rethinking food aid to fight AIDS. Food and Nutrition Bulletin, 25(3), 271–282.PubMedGoogle Scholar
  20. Koenig, S. P., Leandre, F., & Farmer, P. E. (2004). Scaling-up HIV treatment programmes in resource-limited settings: The rural Haiti experience. AIDS (London, England), 18(Suppl. 3), S21–S25. doi:10.1097/00002030-200406003-00005.Google Scholar
  21. Larsson, E. C., Okong, P., Thorson, A., & Ekstrom, A. M. (2007). Antiretroviral treatment of HIV in Uganda: A comparison of three different delivery models in a single hospital. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101(9), 885–892. doi:10.1016/j.trstmh.2007.04.024.CrossRefPubMedGoogle Scholar
  22. Liechty, C. A., & Bangsberg, D. R. (2003). Doubts about DOT: Antiretroviral therapy for resource-poor countries. AIDS (London, England), 17(9), 1383–1387. doi:10.1097/00002030-200306130-00013.Google Scholar
  23. Mills, E. J., Nachega, J. B., Buchan, I., Orbinski, J., Attaran, A., Singh, S., et al. (2006). Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis. Journal of the American Medical Association, 296(6), 679–690. doi:10.1001/jama.296.6.679.CrossRefPubMedGoogle Scholar
  24. Mukherjee, J. S., Ivers, L., Leandre, F., Farmer, P., & Behforouz, H. (2006). Antiretroviral therapy in resource-poor settings: Decreasing barriers to access and promoting adherence. Journal of Acquired Immune Deficiency Syndromes, 43(Suppl. 1), S123–S126. doi:10.1097/01.qai.0000248348.25630.74.PubMedGoogle Scholar
  25. Muyingo, S. K., Walker, A. S., Reid, A., Munderi, P., Gibb, D. M., Ssali, F., et al. (2008). Patterns of individual and population-level adherence to antiretroviral therapy and risk factors for poor adherence in the first year of the DART trial in Uganda and Zimbabwe. Journal of Acquired Immune Deficiency Syndromes, 48(4), 468–475.CrossRefPubMedGoogle Scholar
  26. Nachega, J. B., Knowlton, A. R., Deluca, A., Schoeman, J. H., Watkinson, L., Efron, A., et al. (2006). Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults. A qualitative study. Journal of Acquired Immune Deficiency Syndromes, 43(Suppl. 1), S127–S133. doi:10.1097/01.qai.0000248349.25630.3d.PubMedGoogle Scholar
  27. Partners In Health. (2008). Partners in health 2008 annual report. Available from http://www.pih.org/inforesources/annual/PIH2008_annualreport.pdf.
  28. Pearson, C. R., Micek, M. A., Simoni, J. M., Hoff, P. D., Matediana, E., Martin, D. P., et al. (2007). Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique. Journal of Acquired Immune Deficiency Syndromes, 46(2), 238–244. doi:10.1097/QAI.0b013e318153f7ba.CrossRefPubMedGoogle Scholar
  29. Phillips, A. N., Leen, C., Wilson, A., Anderson, J., Dunn, D., Schwenk, A., et al. (2007). Risk of extensive virological failure to the three original antiretroviral drug classes over long-term follow-up from the start of therapy in patients with HIV infection: An observational cohort study. Lancet, 370(9603), 1923–1928. doi:10.1016/S0140-6736(07)61815-7.CrossRefPubMedGoogle Scholar
  30. Population Reference Bureau. (2006). 2006 World population data sheet. 2006, Available from http://www.prb.org/pdf06/06WorldDataSheet.pdf.
  31. Rosen, S., Fox, M. P., & Gill, C. J. (2007). Patient retention in antiretroviral therapy programs in sub-Saharan Africa: A systematic review. PLoS Medicine, 4(10), e298. doi:10.1371/journal.pmed.0040298.CrossRefPubMedGoogle Scholar
  32. Sarna, A., Luchters, S., Geibel, S., Chersich, M. F., Munyao, P., Kaai, S., et al. (2008). Short- and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: A randomized trial. Journal of Acquired Immune Deficiency Syndromes, 48(5), 611–619.CrossRefPubMedGoogle Scholar
  33. Schafer, J. (1997). Analysis of incomplete multivariate data. New York: Chapman and Hall.Google Scholar
  34. Semba, R. D., Caiaffa, W. T., Graham, N. M., Cohn, S., & Vlahov, D. (1995). Vitamin A deficiency and wasting as predictors of mortality in human immunodeficiency virus-infected injection drug users. The Journal of Infectious Diseases, 171(5), 1196–1202.PubMedGoogle Scholar
  35. Shin, S., Munoz, M., Espiritu, B., Zeladita, J., Sanchez, E., Callacna, M., et al. (2008). Psychosocial impact of poverty on antiretroviral nonadherence among HIV-TB coinfected patients in Lima, Peru. Journal of the International Association of Physicians in AIDS Care, 7(2), 74–81. doi:10.1177/1545109708315326.CrossRefPubMedGoogle Scholar
  36. Shively, M., Smith, T., Bormann, J., & Gifford, A. (2002). Evaluating self-efficacy for HIV disease management skills. AIDS and Behavior, 6, 371–379. doi:10.1023/A:1021156914683.CrossRefGoogle Scholar
  37. Simoni, J. M., Pearson, C. R., Pantalone, D. W., Marks, G., & Crepaz, N. (2006). Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. Journal of Acquired Immune Deficiency Syndromes, 43(Suppl. 1), S23–S35. doi:10.1097/01.qai.0000248342.05438.52.PubMedGoogle Scholar
  38. Smith, S. R., Rublein, J. C., Marcus, C., Brock, T. P., & Chesney, M. A. (2003). A medication self-management program to improve adherence to HIV therapy regimens. Patient Education and Counseling, 50(2), 187–199.PubMedGoogle Scholar
  39. Spacek, L. A., Shihab, H. M., Kamya, M. R., Mwesigire, D., Ronald, A., Mayanja, H., et al. (2006). Response to antiretroviral therapy in HIV-infected patients attending a public, urban clinic in Kampala, Uganda. Clinical Infectious Diseases, 42(2), 252–259. doi:10.1086/499044.CrossRefPubMedGoogle Scholar
  40. Tuboi, S. H., Harrison, L. H., Sprinz, E., Albernaz, R. K., & Schechter, M. (2005). Predictors of virologic failure in HIV-1-infected patients starting highly active antiretroviral therapy in Porto Alegre, Brazil. Journal of Acquired Immune Deficiency Syndromes, 40(3), 324–328. doi:10.1097/01.qai.0000182627.28595.01.CrossRefPubMedGoogle Scholar
  41. Van Der Ven, N. C., Weinger, K., Yi, J., Pouwer, F., Ader, H., Van Der Ploeg, H. M., et al. (2003). The confidence in diabetes self-care scale: psychometric properties of a new measure of diabetes-specific self-efficacy in Dutch and US patients with type 1 diabetes. Diabetes Care, 26(3), 713–718. doi:10.2337/diacare.26.3.713.CrossRefGoogle Scholar
  42. van Oosterhout, J. J., Bodasing, N., Kumwenda, J. J., Nyirenda, C., Mallewa, J., Cleary, P. R., et al. (2005). Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi. Tropical Medicine & International Health, 10(5), 464–470. doi:10.1111/j.1365-3156.2005.01409.x.CrossRefGoogle Scholar
  43. Wainberg, M. A., & Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. Journal of the American Medical Association, 279(24), 1977–1983. doi:10.1001/jama.279.24.1977.CrossRefPubMedGoogle Scholar
  44. Wakabi, W. (2008). Low ART adherence in Africa. The Lancet Infectious Diseases, 8(2), 94. doi:10.1016/S1473-3099(08)70010-0.CrossRefPubMedGoogle Scholar
  45. World Health Organization. (2003). Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach. Available from http://www.who.int/3by5/publications/documents/arv_guidelines/en/.
  46. Wu, A. W., Rubin, H. R., Mathews, W. C., Ware, J. E., Jr, Brysk, L. T., Hardy, W. D., et al. (1991). A health status questionnaire using 30 items from the medical outcomes study. Preliminary validation in persons with early HIV infection. Medical Care, 29(8), 786–798. doi:10.1097/00005650-199108000-00011.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Maribel Muñoz
    • 1
  • Karen Finnegan
    • 2
  • Jhon Zeladita
    • 1
  • Adolfo Caldas
    • 3
  • Eduardo Sanchez
    • 4
  • Miriam Callacna
    • 4
  • Christian Rojas
    • 4
  • Jorge Arevalo
    • 5
  • Jose Luis Sebastian
    • 6
  • Cesar Bonilla
    • 7
  • Jaime Bayona
    • 1
  • Sonya Shin
    • 1
    • 3
    • 8
  1. 1.Socios En Salud Sucursal PerúLimaPeru
  2. 2.Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Division of Global Health EquityBrigham and Women’s HospitalBostonUSA
  4. 4.Hospital Nacional Hipólito UnanueLimaPeru
  5. 5.Hospital Dos de MayoLimaPeru
  6. 6.Peruvian HIV ProgramMinisterio de SaludLimaPeru
  7. 7.Peruvian TB ProgramMinisterio de SaludLimaPeru
  8. 8.Harvard Medical SchoolBostonUSA

Personalised recommendations