Medical News

DAAT May Work Where DOT Model Fell Short

February 5, 2003

This article is part of The Body PRO's archive. Because it contains information that may no longer be accurate, this article should only be considered a historical document.

Researchers at Johns Hopkins have proposed an HIV treatment modeled after directly observed treatment, a successful strategy in treating TB. Directly administered antiretroviral therapy (DAAT) has had good results improving drug adherence in an IDU population on methadone maintenance. Heroin addicts have a very high prevalence of HIV, according to Gregory M. Lucas, M.D., assistant professor at the Johns Hopkins University School of Medicine-Baltimore, and drug users are not typically successful with HIV treatment. Lucas and colleagues presented their findings at the 40th annual meeting of the Infectious Diseases Society of America in Chicago in October 2002.

Investigators found that administering DAAT at a methadone clinic works because patients visit daily. A pilot study started two years ago has 35 people enrolled.

"Somewhere between 70 percent and 80 percent of the people enrolled in the program have achieved an undetectable viral load of less than 400 copies," Lucas explained. The pilot study is not randomized, but investigators are following a cohort study of 2,500 active HIV patients as a matched control group.

In DAAT, patients on methadone therapy are prescribed antiretroviral regimens, and clinicians administer the pills, watching as the patients take them. Then they give them a packet of pills to take later that day.

"It's a modified DOT protocol, which really is done for feasibility purposes," Lucas pointed out. "It's hard to track down people and observe them taking medications twice a day, and it's not realistically done in any outpatient setting."

Low-income racial minorities and women make up many patients at methadone clinics, so the DAAT model helps a hard-to-reach population. Plus, Ryan White programs have already funded a number of slots for methadone treatment for uninsured HIV-infected women.

Lucas said the next step is to study DAAT in a randomized, controlled trial. Investigators are also exploring the option of working with larger methadone treatment clinics in the Baltimore area, he added.

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Adapted from:
AIDS Alert
01.01.03; Vol. 18; No. 1: P. 8

This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.


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