San Francisco researchers have reported preliminary results on a innovative project designed to improve adherence to HAART among homeless or poor people living in the city's most deprived neighbourhoods.
The Action Point Project is a drop-in centre where people can come for daily Directly Observed Therapy (DOT) or to collect medication on a weekly basis. The project also issues TB and psychiatric medications for people with multiple needs. Needle exchange is also available at the same site.
A $10 cash incentive is dispensed weekly to clients that use the service at least once a week. People who have used the project for at least one month can opt to receive a pager that will be programmed to receive reminder messages when they are due to take medication.
Clients can also practice adhering to HAART using vitamins or empty gel caps; this helps clients decide whether they are ready for the commitment of HAART.
The project was designed to assist adherence in a group that has been categorised as unlikely to adhere by some public health officials and doctors. A recent report in the journal AIDS reported a median adherence rate of 73% using MEMScaps amongst another group of homeless or poorly housed patients in San Francisco, indicating that moderate to good adherence is possible despite difficult housing circumstances.
Results
Action Point Adherence Project reports a retention rate of 62% amongst the initial client group of 68 after five months, with 29% lost to follow-up and the remainder either in prison or moved to another area.
At baseline, 60% of clients were receiving anti-retroviral therapy and 52% of these already had viral load below 500 copies.
Viral load data is available on 25 individuals who received therapy for at least two months after their enrolment to the project. Sixty-four per cent had viral load below 500, and 12% had a viral load reduction of greater than 2 log during this period. Only 8% had experienced a viral load increase since joining the programme.
Project manager Dr. Josh Bamberger estimates the annual cost per client at around $4250, equivalent to the cost of one protease inhibitor.
Reference
Bamberger JD et al. Field action report: helping the urban poor stay with antiretroviral drug therapy. American Journal of Public Health 90 (5): 699-701, 2000.
Bangsberg DR. Adherence to protease inhibitors, HIV-1 viral load , and development of drug resistance in an indigent population. AIDS 14: 357-366, 2000.