Background:  Directly administered ART (DAART) is an adherence support strategy that requires patient acceptance to be effective. We describe the acceptability of DAART among an ethnically diverse patient population at 3 public HIV clinics participating in a randomized trial to compare 3 models of adherence support including DAART.

Methods:  For patients in DAART a community worker delivered and observed ingestion of one HAART dose 5 days/week for 6 months at a location of the patient’s choice. Acceptability was evaluated by study participation, retention, attendance, and a satisfaction survey. Odds ratios were used to test for differences between patients who completed and did not complete DAART.

Results:  Between November 2001 and March 2004, 416 patients were identified for the study and 250 enrolled and 166 refused (22 [13%] refused because of concerns related to DAART). We randomized 82 patients to DAART (70% Latino, 20% African American; 72% male; 39% <35 years of age; 69% foreign-born; 69% with income <$10,000/year); 65 (79%) completed 6 months. Patients attended 6908 (85%) of 8122 scheduled visits. The main reason for not completing the study was scheduling conflicts for 7 (40%) of 17 non-completers. Compared with all other racial/ethnic groups, Latinos were more likely to complete DAART (OR = 3.44, 95%CI 1.14 to 10.42) and African Americans were less likely to complete DAART (OR = 0.23, 95%CI = 0.07 to 0.77). Foreign-born patients were more likely to complete DAART than U.S.-born (OR = 3.38, 95%CI = 1.11 to 10.22). Patient experience with DAART was favorable. DAART completers reported that they:  felt comfortable with the number of visits by the community worker (86%); believed the program helped them take their HAART (83%); felt comfortable with the community worker visiting them at their home or work location (86%); liked the convenience of their medications being delivered (88%); and appreciated routine questioning about HAART side effects (86%).

Conclusions:  High rates of attendance and patient satisfaction suggest that a DAART model is an acceptable adherence support strategy in this public clinic population. Higher retention rates among Latino and foreign-born patients indicate that DAART may be a more acceptable adherence strategy among these populations.