[40] DIRECTLY OBSERVED THERAPY (DOT) FOR HIV+ DRUG USERS (IDUs)

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] DIRECTLY OBSERVED THERAPY (DOT) FOR HIV+ DRUG USERS (IDUs)

[AUTHOR(S):] FL Altice, J Mezger, J Hodges, D Bruce, S Springer and GH Friedland
Yale University School of Medicine, AIDS Program, New Haven, CT, USA

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 40
Antiviral Therapy 2003; 8(Suppl. 1):S194

[ABSTRACT:] Background: IDUs have derived less benefit than others due to decreased access to and utilization of antiretroviral (ART). DOT is one approach to improve health outcomes.

Objective: To determine the efficacy of DOT among HIV+ active IDUs.

Methods: Randomized, controlled trial of DOT vs self-administered therapy (SAT) among HIV+ IDUs receiving or eligible for ART. Subjects were randomized by demographic, alcohol severity, ART experience, VL and CD4 characteristics. DOT was provided by a mobile health clinic linked to a syringe exchange program (SEP). Subjects were evaluated at baseline, 1, 3, 6, 9 and 12 months.

Results: Of the initial 85 subjects, 78% are racial minorities and 32% are women. Significant social and medical co-morbidities include: ART-experienced (85%), homelessness (35%), lack of interpersonal support (86%), major depression (49%) and severe alcoholism (21%). Mean baseline parameters: CD4=347, VL=146,333 (log_5.16), adherence=50% (25% self-reported adherence >75%). Regarding overall HIV healthcare use in the previous 6 months, 36% had missed an appointment and 47% used the ER. DOT vs SAT 3-month outcomes, respectively: .VL log (.0.94 vs .0.39, P<0.05), .CD4 (+110 vs +45, P<0.05), VL<400 or 25% CD4↑ (39% vs 18%, P<0.05). HIV+ IDUs with baseline VL<1000 were unlikely to have a VL↑ irrespective of DOT or SAT.

Conclusions: Active IDUs with HIV have significant social and medical co-morbidity and disenfranchisement from the health care system. Despite these obstacles, they have improved health outcomes while on DOT. HIV+ IDUs with baseline viral suppression do not need DOT and such resource-consuming efforts should be reserved for those who might benefit most.

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