Directly Observed Therapy to Treat HIV Infection in Prisoners

Antiretroviral Treatment in Correctional Facilities

“…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. 24 Discordant opinions exist about the introduction of the DOT strategy for ART administration in prisons.…”

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.…”

Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

“…[34][35][36] The results of our study are also similar to those obtained in correctional settings and noncorrectional settings with mandatory directly observed therapy (DOT) for HAART. [37][38][39] One recent study compared patients enrolled in clinical trials who received directly observed HIV therapy in a correctional setting to those in trials in community settings. 40 Results of this study showed that 80% of patients receiving DOT achieved a nondetectable viral load compared to 50% in the selected community-derived sample.…”

“…40 Rates of nondetectable viral load in patients receiving HAART in clinical care settings average [41][42][43] around 50%. While DOT has been demonstrated to provide a structural intervention for the treatment of tuberculosis, 1,44 limited feasibility has been demonstrated for the management of HIV outside highly structured correctional, 39,40 skilled nursing, 45 and methadone maintenance settings. 46 Modified directly observed therapy (mDOT) has been suggested, but feasibility has yet to be demonstrated in community settings.…”