Attitudes to directly observed antiretroviral treatment in a workplace HIV care programme in South Africa

Abstract

ART by DOT was not an immediately popular concept with our patients, primarily because of a desire to retain responsibility for their own treatment. More work is needed to understand what key elements of treatment support are needed to promote adherence.

Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of- care in Kenya

“…A few previous studies indicated that patients did not favour m-DOT due to confidentiality concerns (Liechty & Bangsberg, 2003;Page-Shipp et al, 2007;Santos et al, 2006). Therefore, despite the findings of our study, concerns about confidentiality, together with persisting high levels of stigma, show that much care still needs to be taken to ensure that HIV-related interventions do not increase stigma.…”

“…Two cross-sectional studies [in South Africa: (Page-Shipp et al, 2007); in the US: Santos et al, 2006)] focused on attitudes to directly-observed ART. Some participants thought that the m-DOT approach was unnecessary (since they could self-administer the drugs) and intrusive due to loss of privacy, and interference with family, work or home life.…”

“…Innovative strategies such as modified directly observed therapy (m-DOT) have been used in ART programmes to support adherence (Abusabha & Woelfel, 2003;Altice, Maru, Bruce, Springer, & Friedland, 2007;Christopher, 2006;Farmer et al, 2001;Macalino et al, 2007;Mills, Nachega, Bangsberg et al, 2006;Mitchell, Freels, Creticos, Oltean, & Douglas, 2007;Munoz et al, in press;Page-Shipp et al, 2007;Pearson et al, 2007;Pearson et al, 2006). The m-DOT strategy typically involves clinic staff or trained peers observing patients ingesting only some of their ART doses while the rest of the medication is self-administered by the patient (Page-Shipp et al, 2007;Simoni et al, 2008).…”

“…The m-DOT strategy typically involves clinic staff or trained peers observing patients ingesting only some of their ART doses while the rest of the medication is self-administered by the patient (Page-Shipp et al, 2007;Simoni et al, 2008). Observations are tapered at some point under the assumption that the patients have internalised the drug-taking behaviour and will maintain adherence to all medication without further support (Simoni et al, 2008).…”

Directly observed antiretroviral therapy: a systematic review and meta-analysis of randomised clinical trials

“…Such lack of success in both meta-analyses could be caused by attrition due to intensive clinic visitation requirements for daily observation that not all patients can meet, 37 resistance by patients to losing their autonomy 38 and a desire to take responsibility for their own treatment, 39 absence of actual delivery of the intervention, or patients maintaining excellent adherence irrespective of the intervention, indicating that selfadministered treatment is successful for long-term care. 6 Additionally, treatment eff ects were small across all trials, such that a much larger sample size would be needed to measure an eff ect; small trials in general populations are underpowered to show important eff ects.…”