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Doubts about DOT: antiretroviral therapy for resource-poor countries
Cheryl A Liechty1, David R Bangsberg
1Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, Kampala, Uganda.
AIDS (London, England)
|June 12, 2003
Summary
Directly observed therapy for HIV is not yet proven effective. Evidence for witnessed dosing is weak, and potential negative impacts like drug resistance and stigmatization are overlooked in resource-poor settings.
Area of Science:
- Public Health
- Infectious Diseases
- Global Health
Background:
- Directly observed therapy (DOT) for tuberculosis (TB) has been proposed as a model for HIV medication delivery in resource-poor settings.
- The goal is to improve adherence and prevent the emergence of drug resistance.
Purpose of the Study:
- To evaluate the appropriateness of directly observed therapy (DOT) for HIV treatment in resource-poor countries.
- To critically assess the evidence supporting DOT for HIV and its potential drawbacks.
Main Methods:
- A comprehensive review of scientific literature was conducted.
- Key areas examined included DOT effectiveness for TB, HIV antiretroviral therapy (ART) adherence in various settings, and the link between adherence, drug resistance, and HIV transmission.
Main Results:
- Evidence supporting the superiority of witnessed dosing over self-administered therapy for HIV is equivocal.
- Assumptions about adherence in resource-poor settings may be flawed.
- Good adherence could paradoxically increase HIV drug resistance.
- The efficacy of ART in preventing HIV transmission and potential stigmatization are not fully established.
Conclusions:
- Enthusiasm for DOT programs for HIV is premature.
- Further research is needed to validate the benefits and address the risks, including drug resistance and patient stigmatization, before widespread implementation in resource-poor settings.