Attitudes toward directly administered antiretroviral therapy (DAART) among HIV-positive inpatients in an inner city public hospital

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Abstract
Directly administered antiretroviral therapy (DAART) is one approach to improve adherence among HIV-positive individuals. DAART has been assessed for confined participants such as prisoners and for patients enrolled in methadone clinics but community-based voluntary DAART programs are not well studied. We examined the attitudes toward DAART among 47 HIV-positive inpatients in an inner city public hospital, a population difficult to engage in conventional self-administered highly active antiretroviral therapy (HAART). This study found that 83% of participants prefer self-administered therapy (SAT) and only 17% elect for DAART. A significant proportion of participants think the approach is intrusive or impractical and few are willing to meet with providers daily. A proportion of our patients, however, struggle with medication non-adherence and fragmented medical care, evident in the high rates of missed clinic appointments, frequent emergency department visits and repeated hospitalizations. These data can inform the development of DAART programs and suggest that considerable effort is needed to 'sell' the idea of DAART to this patient population. It is likely that such patients will greatly benefit from a clinic that can provide intensive counseling, frequent follow-up, home visits and DAART. Patient education regarding the merits of such an approach will be key to success.