Doubts about DOT: Antiretroviral therapy for resource-poor countries

Cheryl A. Liechty, David Bangsberg

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Introduction: Directly observed therapy programs developed for tuberculosis (TB) have been suggested as a model for the provision of HIV medications in resource-poor countries in order to ensure adherence and prevent drug resistance. Methods: Opinions were formed based on a review of scientific literature regarding the effectiveness of witnessed dosing in directly observed TB therapy programs, adherence to HIV antiretroviral therapy in resource-rich and resource-poor settings, relationship between adherence and HIV antiretroviral drug resistance, HIV viral load and risk of HIV transmission, and stigmatization concerns related to HIV and TB in resource-poor settings. Results/conclusions: We suggest that the enthusiasm for HIV directly observed therapy programs is premature based on: equivocal evidence that witnessed dosing is superior to self administered therapy; mistaken assumptions that resource-poor countries are a 'special case' with respect to adherence; possible paradoxical impact of good adherence on HIV drug resistance; unproven efficacy of antiretroviral therapy in preventing HIV transmission; and potential stigmatization of daily antiretroviral dosing.

Original languageEnglish (US)
Pages (from-to)1383-1387
Number of pages5
JournalAIDS
Volume17
Issue number9
DOIs
StatePublished - Jun 13 2003
Externally publishedYes

Fingerprint

HIV
Directly Observed Therapy
Drug Resistance
Stereotyping
Tuberculosis
Therapeutics
Viral Load

Keywords

  • Adherence
  • Africa
  • Directly observed therapy
  • HIV antiretroviral therapy
  • Resistance
  • Resource-poor

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Doubts about DOT : Antiretroviral therapy for resource-poor countries. / Liechty, Cheryl A.; Bangsberg, David.

In: AIDS, Vol. 17, No. 9, 13.06.2003, p. 1383-1387.

Research output: Contribution to journalArticle

Liechty, Cheryl A. ; Bangsberg, David. / Doubts about DOT : Antiretroviral therapy for resource-poor countries. In: AIDS. 2003 ; Vol. 17, No. 9. pp. 1383-1387.
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