Directly administered antiretroviral therapy: Pilot study of a structural intervention in methadone maintenance

Sorensen, James L.; Haug, Nancy A.; Larios, Sandra E.; Gruber, Valerie A.; Tulsky, Jacqueline P.; Powelson, Elisabeth B; Logan, Deborah P.; Shapiro, Bradley

doi:10.1016/j.jsat.2012.08.014

Cited by 22 publications

(27 citation statements)

References 23 publications

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“…Assessing virologic outcomes was limited by methodologic issues—for example, cutoffs for viral suppression varied from < 20 to < 400 copies/ml (limiting comparability), some patients met criteria for viral suppression at some time points but not longitudinally, and some studies reported viral loads but did not formally assess viral suppression. Among the 8 studies that achieved at least 80% virologic suppression [27–34], the types of interventions varied [3 directly administered ART (DAART), 2 behavioral/counseling, 2 pharmacy-based and 1 education], as did the target population being addressed (6 general, 1 women, 1 PWUD), and the type of study design (4 RCTs, 1 cohort, 3 pre-post). Nonetheless, only four of these studies [27, 29, 32, 34] found a significant improvement in viral suppression in the intervention group versus the comparator group.…”

Section: Resultsmentioning

confidence: 99%

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

et al. 2017

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In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. ‘Linkage’ studies utilized 11 different outcome definitions, while ‘retention’ studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.

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Section: Resultsmentioning

confidence: 99%

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

et al. 2017

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“…One study is piloting a novel, multilevel Directly Administered AntiRetroviral Treatment intervention to improve long-term ART medication adherence and reduce HIV-1 RNA viral load in methadone maintenance patients (75). Another study is testing the efficacy of an on-site HIV and Hepatitis Care Coordination intervention to increase hepatitis vaccination and attendance at HIV and/or HCV medical care intake (76,77).…”

Section: Activities and Resultsmentioning

confidence: 99%

NIDA’s Clinical Trials Network: An Opportunity for HIV Research in Community Substance Abuse Treatment Programs

Tross

Campbell

Calsyn

et al. 2011

The American Journal of Drug and Alcohol Abuse

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Background/Objectives HIV continues to be a significant problem among substance users and their sexual partners in the United States. The National Drug Abuse Treatment Clinical Trials Network (CTN) offers a national platform for effectiveness trials of HIV interventions in community substance abuse treatment programs. This article presents the HIV activities of the CTN during its first 10 years. Results While emphasizing CTN HIV protocols, this article reviews the (1) HIV context for this work; (2) the collaborative process among providers, researchers, and National Institute on Drug Abuse CTN staff, on which CTN HIV work was based; (3) results of CTN HIV protocols and HIV secondary analyses in CTN non-HIV protocols; and (4) implications for future HIV intervention effectiveness research in community substance abuse treatment programs. Conclusion/Significance While the feasibility of engaging frontline providers in this research is highlighted, the limitations of small to medium effect sizes and weak adoption and sustainability in everyday practice are also discussed.

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“…It was determined that directly observing therapy, as a long-term intervention strategy, requires significant up-front planning and flexibility (Sorensen et al, 2012). Alternatives such as motivational interviewing, contingency management, pill boxes, calendar marking, or cell phone reminders could be practiced in lieu of or in tandem with direct observation.…”

Section: Discussionmentioning

confidence: 99%

“…The contents and procedures of the integrated ART services were initially developed based on previous research (Achmad et al, 2009;Berg et al, 2011; Sorensen et al, 2012; Wolfe et al, 2010) and our experience with MMT providers and clients (Li et al, 2013), and were finalized collaboratively by the research team and local expert panel. The following services were designed to be delivered by the MMT clinics:

Direct observed therapy : clients on ART were encouraged to adjust their medication habits in conjunction with methadone dosage (e.g., taking ART under the direct observation of a service provider once a day).

Reminder services : all HIV-positive clients were provided reminders for routine CD4/viral load testing.

…”

Section: Methodsmentioning

confidence: 99%

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Integrating antiretroviral therapy in methadone maintenance therapy clinics: Service provider perceptions

Lin

Cao²,

2014

International Journal of Drug Policy

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Background Using methadone maintenance therapy (MMT) clinics to deliver antiretroviral therapy (ART) is an effective strategy to promote treatment initiation and adherence for HIV-positive drug users. This paper describes the implementation barriers perceived by service providers for an intervention pilot designed to integrate ART services in MMT clinics. Methods The study was conducted in six MMT clinics in Sichuan province, China. Two service providers selected from each of the six clinics underwent training in administering ART. The trained providers delivered ART-related services in their clinics. A focus group was conducted among the service providers to assess their experiences and perceived challenges in delivering integrated services. Results Barriers at policy, institutional, provider, and client levels were identified. Policy level barriers included household registration restrictions and a lack of insurance coverage for testing expenses. Inefficient coordination between treatment sites and MMT clinics was an obstacle at the institutional level. Insufficient training and added workload were barriers at the provider level. Finally, conflict with daily dosing habits was identified as the primary reason that clients did not accept ART. Conclusion Although integrating ART into MMT clinics is beneficial, multilevel barriers to implementation need to be addressed. This study documents the need for treatment transferability and insurance coverage, protection of client confidentiality, proper provider training, coordination with treatment sites, and individualized ART service for MMT clients.

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Directly administered antiretroviral therapy: Pilot study of a structural intervention in methadone maintenance

Cited by 22 publications

References 23 publications

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

NIDA’s Clinical Trials Network: An Opportunity for HIV Research in Community Substance Abuse Treatment Programs

Integrating antiretroviral therapy in methadone maintenance therapy clinics: Service provider perceptions

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