February 3, 2003
Directly observed therapy, in which a health worker watches a patient take medication, proved workable for TB because the disease can be cured within six months to a year, and medication can be taken twice weekly. With HIV, treatment lasts a lifetime and medicine has to be taken twice daily in most regimens.
Despite the obstacles, the health department bought two used vans, and workers began the program last spring, hand-delivering medication to 27 patients unlikely to stay in treatment without help. It is a labor-intensive program in a city that counts more than 12,000 cases of HIV.
Michele Brown, program director, has seen remarkable changes in the patients' health and quality of life, although she has no statistical proof that the program is working. Beilenson concedes that the program cannot expand without proof. Consultants from the Johns Hopkins Bloomberg School of Public Health plan a forthcoming study to measure patients' compliance and drug resistance.
The University of Maryland Medical Center is planning a flexible program combining home visits for some patients and pairing with "coaches" -- experienced patients -- for others. Providence, R.I., caseworkers visit patients daily at first, then try to taper down to one or two visits a week. They leave several days' worth of medications and make spot visits to check compliance. Providence started the nation's first directly observed program for HIV patients in 1998.
01.28.03; Jonathan Bor