Department of Psychiatry, University of California, San Francisco, USA.
J Subst Abuse Treat. 2012 Dec;43(4):418-23. doi: 10.1016/j.jsat.2012.08.014. Epub 2012 Sep 21.
Devising interventions to provide integrated treatment for addiction and medical problems is an urgent issue. This study piloted a structural intervention, Directly Administered Antiretroviral Therapy (DAART), to assist methadone-maintenance patients in HIV medication adherence. Twenty-four participants received: (1) antiretroviral medications at the methadone clinic daily before receiving their methadone; (2) take-home antiretroviral medication for days they were not scheduled to attend the methadone clinic, and (3) brief adherence counseling to address adherence barriers. DAART lasted 24 weeks, with a planned step-down to twice-weekly administration in weeks 25-36, followed by self-administration in weeks 37-48. Retention rates at weeks 24, 36, and 48 were 83, 92, and 75% respectively. DAART was associated with improvement in the proportion of participants achieving viral suppression as well as with high medication adherence rates (clinic-verified; 85% and self-reported 97%) during the active intervention phase. DAART was effective as an intervention but did not promote transition to self-administration. This study demonstrates that DAART is adaptable and simple enough to be implemented into methadone treatment programs interested in providing HIV adherence services.
制定综合治疗成瘾和医疗问题的干预措施是当务之急。本研究试点了一种结构性干预措施，即直接给予抗逆转录病毒治疗（DAART），以帮助美沙酮维持治疗患者坚持接受 HIV 药物治疗。24 名参与者接受了以下治疗：（1）在接受美沙酮之前，每天在美沙酮诊所接受抗逆转录病毒药物治疗；（2）在未安排到美沙酮诊所就诊的日子里，携带抗逆转录病毒药物回家；（3）接受简短的坚持治疗咨询，以解决坚持治疗的障碍。DAART 持续 24 周，计划在第 25-36 周减少至每周两次给药，然后在第 37-48 周自行给药。第 24、36 和 48 周的保留率分别为 83%、92%和 75%。DAART 与提高病毒抑制比例以及在积极干预阶段实现高药物坚持率（诊所验证：85%和自我报告 97%）相关。DAART 作为一种干预措施是有效的，但并没有促进向自我管理的过渡。本研究表明，DAART 适应性强，足够简单，可以纳入有兴趣提供 HIV 坚持治疗服务的美沙酮治疗计划。
