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Session 106 Poster Abstracts
Adherence to Antiretroviral Therapy in Developing Countries
Wednesday, 1:30 - 3:30 pm
Hall A


629    
DOT HAART in a Resource-limited Setting: The Use of Community Treatment Support Can Be Effective
John Idoko*1, O Agbaji1, P Kanki2, and J Sankale2
1Univ of Jos, Nigeria and 2Harvard Sch of Publ Hlth, Boston, MA, USA

Background:  Data have demonstrated that a 95% rate of adherence to antiretroviral therapy (ART) was associated with a superior virologic outcome and a greater increase in CD4 counts. Maintaining high levels of adherence to antiretroviral drugs has been reported to increase the likelihood of complete and durable viral suppression. In Nigeria, the widespread use of ART in a setting of limited monitoring of viral response, poor adherence education, and an interrupted medication supply has the potential to quickly result in wide scale resistance. Adherence to antiretroviral therapy may therefore be particularly challenging and hence may require the exploration of different interventions.

Method:  A 12-month observational study enrolling 173 antiretroviral naïve patients into 4 arms to examine various community treatment support models using family and community members was carried out. The study employed sustained adherence education and daily directly observed therapy (DOT) HAART, twice weekly observation therapy, weekly observational therapy, and self-administered therapy. All patients received generic combination of stavudine (d4T), lamivudine (3TC), and nevirapine (NVP). Community treatment support personnel included patients’ spouses or partners, family members, friends, and members of the hospital HIV-positive support group.

Results:  The results at 48 weeks showed a self-reported adherence of 98% for the DOT and the self-treatment groups. Plasma HIV-1 RNA reached undetectable levels (< 400 copies/mL) in 91%, 85%, 86%, and 85% of patients in the 4 groups, respectively, at month 6. The CD4 counts increased by 224, 269, 204, and 232 in 4 groups, respectively, after 48 weeks of treatment.

Conclusions:  The virologic and immunologicresponses to treatment at 48 weeks demonstrate that in resource-limited settings, the use of family and community members to implement DOT HAART can greatly enhance adherence to ART and therefore ensure a durable virologic response to ART.

Keywords: Antiretroviral therapy; DOT-HAART; Community support