莫桑比克针对同伴提供的改良直接观察性高效抗逆转录病毒治疗（HAART）的随机对照试验。
Randomized control trial of peer-delivered, modified directly observed therapy for HAART in Mozambique.
作者信息
Pearson Cynthia R, Micek Mark A, Simoni Jane M, Hoff Peter D, Matediana Eduardo, Martin Diane P, Gloyd Stephen S
机构信息
Department of Psychology, University of Washington, Seattle, WA 98195-1525, USA.
出版信息
J Acquir Immune Defic Syndr. 2007 Oct 1;46(2):238-44. doi: 10.1097/QAI.0b013e318153f7ba.
OBJECTIVE
To assess the efficacy of a peer-delivered intervention to promote short-term (6-month) and long-term (12-month) adherence to HAART in a Mozambican clinic population.
DESIGN
A 2-arm randomized controlled trial was conducted between October 2004 and June 2006.
PARTICIPANTS
Of 350 men and women (> or = 18 years) initiating HAART, 53.7% were female, and 97% were on 1 fixed-dose combination pill twice a day.
INTERVENTION
Participants were randomly assigned to receive 6 weeks (Monday through Friday; 30 daily visits) of peer-delivered, modified directly observed therapy (mDOT) or standard care. Peers provided education about treatment and adherence and sought to identify and mitigate adherence barriers.
OUTCOME
Participants' self-reported medication adherence was assessed 6 months and 12 months after starting HAART. Adherence was defined as the proportion of prescribed doses taken over the previous 7 days. Statistical analyses were performed using intention-to-treat (missing = failure).
RESULTS
Intervention participants, compared to those in standard care, showed significantly higher mean medication adherence at 6 months (92.7% vs. 84.9%, difference 7.8, 95% confidence interval [CI]: 0.0.02, 13.0) and 12 months (94.4% vs. 87.7%, difference 6.8, 95% CI: 0.9, 12.9). There were no between-arm differences in chart-abstracted CD4 counts.
CONCLUSIONS
A peer-delivered mDOT program may be an effective strategy to promote long-term adherence among persons initiating HAART in resource-poor settings.
目的
评估在莫桑比克一家诊所中，由同伴提供的干预措施对促进短期（6个月）和长期（12个月）高效抗逆转录病毒治疗（HAART）依从性的效果。
设计
2004年10月至2006年6月期间进行了一项双臂随机对照试验。
参与者
在开始接受HAART治疗的350名男性和女性（≥18岁）中，53.7%为女性，97%每天服用1种固定剂量复方药丸，服用两次。
干预措施
参与者被随机分配接受为期6周（周一至周五；每天30次访视）的由同伴提供的改良直接观察治疗（mDOT）或标准护理。同伴提供有关治疗和依从性的教育，并试图识别和缓解依从性障碍。
结果
在开始HAART治疗6个月和12个月后，评估参与者自我报告的药物依从性。依从性定义为前7天服用的规定剂量的比例。采用意向性分析（缺失=失败）进行统计分析。
结果
与接受标准护理的参与者相比，干预组参与者在6个月时的平均药物依从性显著更高（92.7%对84.9%，差异7.8，95%置信区间[CI]：0.02，13.0），在12个月时也是如此（94.4%对87.7%，差异6.8，95%CI：0.9，12.9）。两组间在病历摘要中的CD4细胞计数无差异。
结论
在资源匮乏地区，由同伴提供的mDOT项目可能是促进开始接受HAART治疗的人群长期依从性的有效策略。
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