Directly observed antiretroviral therapy improves adherence and viral load in drug users attending methadone maintenance clinics: A randomized controlled trial

Karina M. Berg, Alain Litwin, Xuan Li, Moonseong Heo, Julia H. Arnsten

Research output: Contribution to journalArticle

76 Scopus citations

Abstract

Objective: To determine if directly observed antiretroviral therapy (DOT) is more efficacious than self-administered therapy for improving adherence and reducing HIV viral load (VL) among methadone-maintained opioid users. Design: Two-group randomized trial. Setting: Twelve methadone maintenance clinics with on-site HIV care in the Bronx, New York. Participants: HIV-infected adults prescribed combination antiretroviral therapy. Main outcomes measures: Between group differences at four assessment points from baseline to week 24 in: (1) antiretroviral adherence measured by pill count, (2) VL, and (3) proportion with undetectable VL (<75. copies/ml). Results: Between June 2004 and August 2007, we enrolled 77 participants. Adherence in the DOT group was higher than in the control group at all post-baseline assessment points; by week 24 mean DOT adherence was 86% compared to 56% in the control group (p< 0.0001). Group differences in mean adherence remained significant after stratifying by baseline VL (detectable versus undetectable). In addition, during the 24-week intervention, the proportion of DOT participants with undetectable VL increased from 51% to 71%. Conclusions: Among HIV-infected opioid users, antiretroviral DOT administered in methadone clinics was efficacious for improving adherence and decreasing VL, and these improvements were maintained over a 24-week period. DOT should be more widely available to methadone patients.

Original languageEnglish (US)
Pages (from-to)192-199
Number of pages8
JournalDrug and Alcohol Dependence
Volume113
Issue number2-3
DOIs
StatePublished - Jan 15 2011

Keywords

  • Directly observed therapy
  • HIV
  • Medication adherence
  • Methadone
  • Randomized trial

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Fingerprint Dive into the research topics of 'Directly observed antiretroviral therapy improves adherence and viral load in drug users attending methadone maintenance clinics: A randomized controlled trial'. Together they form a unique fingerprint.

  • Cite this