Skip Ribbon Commands
Skip to main content

Title

Effect of directly observed therapy for highly active antiretroviral therapy on virologic, immunologic, and adherence outcomes

Authors

Hart JE, Jeon CY, Ivers LC

Network Affiliation

Other

Organization

 

Journal Name

JAIDS

Publication Date

1/1/2011

PubMed Search

http://www.ncbi.nlm.nih.gov/pubmed/20375848

Link to full-text

 

PMID

20375848

Abstract

INTRODUCTION: Directly observed therapy of highly active antiretroviral therapy (DOT-HAART) is a feasible adherence intervention. Prospective DOT-HAART studies have shown mixed results, and optimal target groups have yet to be defined. We performed a meta-analysis and systematic review to assess the effect of DOT-HAART on adherence and virologic and immunologic response.
METHODS: We performed a comprehensive search through August 2009 to identify peer-reviewed controlled studies that involved outpatient DOT-HAART among adults and reported at least 1 outcome assessed in this meta-analysis. Random-effects meta-analyses were performed; differences in effect on virologic suppression were examined using stratified meta-analyses and meta-regression on several study characteristics.
RESULTS: Seventeen studies met inclusion criteria. Compared with control groups, DOT-HAART recipients were more likely to achieve an undetectable viral load (random effects risk ratio 1.24, 95% confidence interval (CI): 1.08 to 1.41), a greater increase in CD4 cell count (random effects weighted mean difference 43 cells/microL, 95% CI: 12 to 74 cells/microL), and HAART adherence of > or =95% (random effects risk ratio 1.17, 95% CI: 1.03 to 1.32). Results varied with respect to virologic response. DOT-HAART did not have a significant effect on virologic suppression when restricted to randomized controlled studies. Post-treatment effect was not observed in a limited number of studies.
CONCLUSIONS: DOT-HAART had a significant effect on virologic, immunologic, and adherence outcomes, although its efficacy was not supported when restricting analysis to randomized controlled trials. DOT-HAART shows greatest treatment effect when targeting individuals with greater risk of nonadherence and when delivering the intervention that maximizes participant convenience and provides enhanced adherence support. Further investigation is needed to assess the postintervention effect and cost-effectiveness of DOT-HAART.

Keywords

 

Topic

Adherence; DOT-HAART

Attachments

Created at 1/7/2011 12:29 PM by Mooney, Jessica L
Last modified at 1/7/2011 12:29 PM by Mooney, Jessica L