When "access to antiretroviral treatment for all" is not enough

Adriana Campa, Dushyantha T. Jayaweera, Carlin Rafie, Sabrina Sales, J. Bryan Page, Marianna K. Baum

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Abstract

Objective: To evaluate the effect of active case management and incentives on compliance with scheduled study visits as compared to compliance with visits to monitor antiretroviral therapy (ART) and viral control for 6 months in a cohort of 144 HIV-drug users on ART in Miami. Methods: A prospective 6-month study to compare participant compliance with research visits using active case management, incentives, and close follow-up, versus their compliance with routine healthcare visits to monitor ART and viral load during the same time period. Attendance at research visits and routine healthcare visits was recorded, and CD4 cell count and viral load were measured at baseline and 6-months. Active case management included monthly scheduled visits to assess compliance with nutritional supplementation study protocol, follow-up of participants missing visits, and incentives for attendance at all visits. Descriptive statistics and Student's t-test for proportions was used in the analyses. Results: Compliance with study visits in which active case management was used was 86% compared to 17.4% with routine self-directed healthcare ART monitoring visits. Only 29.8% of those receiving ART achieved viral suppression (<400 copies/mL). Conclusions: In patients who are at high risk for non-adherence, active case management and incentives need to be implemented to achieve compliance with treatment in order to control the HIV epidemic more effectively.

Original languageEnglish (US)
JournalPublic Administration and Management
Volume12
Issue number3
StatePublished - Dec 1 2007

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ASJC Scopus subject areas

  • Public Administration

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