Adherence to Directly Observed Antiretroviral Therapy among Human Immunodeficiency Virus--Infected Prison Inmates

Abstract

Directly observed therapy (DOT) for human immunodeficiency virus (HIV) infection is commonly used in correctional settings; however, the efficacy of DOT for treating HIV infection has not been determined. We prospectively assessed adherence to antiretroviral therapy regimens among 31 HIV-infected prison inmates who were receiving >or=1 antiretrovirals via DOT. Adherence was measured by self-report, pill count, electronic monitoring caps, and, for DOT only, medication administration records. Overall, median adherence was 90%, as measured by pill count; 86%, by electronic monitoring caps; and 100%, by self-report. Adherence, as measured by electronic monitoring caps, was >90% in 32% of the subjects. In 91% of cases, adherence, as measured by medication administration records, was greater than that recorded by electronic monitoring caps for the same medications administered by DOT. Objective methods of measurement revealed that adherence to antiretroviral regimens administered wholly or in part by DOT was <or=90% in more than one-half of the patients. Different methods used to measure adherence revealed significantly different levels of adherence. These findings suggest that use of DOT does not ensure adherence to antiretroviral therapy.

Antiretroviral Treatment in Correctional Facilities

“…DOT), although there was variability between the different measurement techniques. 43 In addition, in this study, 68% of the participants responded that they would prefer to take medications on their own rather than having them provided via DOT. This could mean that motivated patients may be fully adherent even if not strictly supervised as in the case of DOT.…”

“…43 A study performed in North Carolina showed that the extent of adherence to prescribed individual agents in a combination regimen did not appear to depend on the method of administration (SAT vs. DOT), although there was variability between the different measurement techniques.…”

“…However, the median level of adherence to ARV regimens in which ≥ 1 medication was administered by DOT was suboptimal, as recorded by the most objective adherence measurements; more than one half of the participants had adherence rates that would not be expected to provide lasting viral suppression. 43 An Italian study comparing DOT with modified DOT showed that the DOT group had significantly better virological and immunologic results than the other one. 44 On the other side, a US study showed no differences in adherence to ART for patients receiving DOT and those who self-administered their medication.…”

The impact of medication regimen factors on adherence to chronic treatment: a review of literature

“…Eldred et al (1998), in an early study of combination therapy adherence, found that dosing frequency was related to better adherence; patients on twice-daily regimens were more adherent than those on thrice-daily regimens (odds ratio = 1.44; 95% confidence interval 1.01-1.96). Wohl et al (2003) reported in a study of directly observed therapy among prisoners that any regimen requiring more than one medication per day resulted in sub-optimal adherence that would not likely maintain viral suppression. Trotta et al (2002) identified that achieving undetectable HIV viral load was strongly associated with fewer daily pills in a meta-analysis of 23 RCTs examining triple combination therapy for HIV.…”

Directly Observed versus Self-administered Antiretroviral Therapies: Preference of HIV-Positive Jailed Inmates in San Francisco

“…[13][14][15] However, there are concerns regarding lack of confidentiality and stigma, [16][17][18][19] as well as sustained benefits of DOT after release from correctional facilities, when patients must transition to self-administra-tion of medications. Data show that the proportion of those who continue ARVs immediately after release is low, 16,[20][21][22][23][24] which is particularly important, as the postrelease period is a time of high-risk behaviors.…”