[Directly observed anti-retroviral therapy amongst female inmates]

It is considered that the gold standard for success in HAART is adherence. To improve adherence amongst inmates with HIV-AIDS, the use of directly observed treatment (DOT) is proposed using the tuberculosis treatment model.

HIV positive female patients with ARVT criteria who voluntarily participated were used for the study. The initial and final CD4 cell count and HIV viral load were the principal data used for assessment purposes.

52 women with an average age of 34 years were studied, with an average HIV infection time span of between 1 and 20 years. Initial CD4 cell count of <100 copies/mL in 16 patients (30.7%) and an equivalent final count in 4 patients (7.6%) were found. Initial undetectable viral loads were not found in any patient, while final undetectable viral loads were found in 33 (63.4%). 21% of patients had opportunistic infections. The most important of these was tuberculosis, followed by HCV co-infection. The most frequently used ARVT schedule was two NRTI with one NNTRI.

The application of DOT strategy to ARVT was effective amongst our patients, as shown by the increase in CD4 counts and the increased number of patients with reductions in viral loads to undetectable levels. While it is a tool that is not easy to use for cases of chronic treatment, we do consider it to be useful for prison inmates.