PROJECT I: TREATING THE UNTREATABLE IN THE INNER CITY

Click here to be taken to the Duncan and Craig Laural Award web site

2003 Laurel Award Recipient
	EDMONTON DIRECTLY OBSERVED THERAPY (DOT) FOR HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART)
	PROJECT I: TREATING THE UNTREATABLE IN THE INNER CITY
	P Akai1, K Lavender1,2, M Foisy1,3 1DOT for HAART Project and Boyle-McCauley Health Centre; 2University of Alberta; 3Royal Alexandra Hospital, Edmonton, Alberta
	Background: Human immunodeficiency virus (HIV) positive patients with a history of homelessness or a chaotic lifestyle are typically considered poor candidates for HAART because of their potential non-compliance. Such patients may benefit from daily DOT in an appropriate setting to increase adherence to HAART.
	Objective: To demonstrate efficacy of a DOT for HAART program in promoting adherence to HAART and decreased HIV-related morbidity for traditionally non-compliant HIV-positive patients in inner-city Edmonton. Methods: Appropriate and effective incentives and psychosocial supports are provided to encourage a homeless or high risk inner city HIV positive population to adhere to daily DOT for HAART. Patients are referred by HIV specialist physicians who also establish and maintain appropriate once or twice daily HAART regimens for each patient. Indicators of efficacy include adequate patient representation, high patient adherence rates and HIV awareness, decreased HIV viral loads, increased CD4 counts, improved general health indicators and collaborative interactions with the HIV treatment community.
	Results: The project successfully reaches its target population and has attained its daily DOT for HAART adherence goals of over 85%. Significant viral load and CD4 count improvements have occurred, and general health and appropriate health care access are maintained for all compliant patients. In addition, the program referral base includes nine HIV physicians and also collaborates with the sexually transmitted diseases clinic, Remand Centre, and HIV community groups in Edmonton. Conclusions: DOT for HAART can be effectively delivered to a traditionally non-compliant and untreatable HIV positive inner-city population. This improves HIV disease parameters and overall health and may contribute to decreased HIV drug resistance and transmission.