Baltimore to Launch Directly Observed Therapy Program for HIV-Positive Individuals

Baltimore, Md., health officials, hoping to stop the spread of drug-resistant strains of HIV, will launch a pilot program this week to monitor individuals with HIV/AIDS and ensure that "they take their medications twice a day, every day," the Baltimore Sun reports. City Health Commissioner Dr. Peter Beilenson said yesterday that the program will initially target 200 people, who will receive medications at either a public health clinic, a pharmacy or a van in the neighborhoods of West Baltimore, which have been "devastated by AIDS." The program will be modeled after the "directly observed therapy" (DOT) technique successfully used to treat people with tuberculosis -- health workers will "watch the patients swallow all their pills." Beilenson said that his agency on Thursday will "put the word out" to individuals at the city's needle-exchange vans; those who show an interest will then be evaluated by health professionals. Researchers from Johns Hopkins University's Bloomberg School of Public Health will evaluate the program, "using such benchmarks as the frequency with which patients show up at their assigned locations." The program will cost Baltimore, which has about 6,000 residents who are HIV-positive, $120,000 a year, most of which will go for salaries and a new van. A state program that provides HIV/AIDS medications to low- and middle-income individuals will pay for the prescriptions.

No Guarantees
While the program will initially be limited to 200 people, it still will be the "largest of its kind in the United States" and is thus a "risky" strategy. "We're trying something new and we think it's a reasonable initiative. But it's certainly not a guarantee," Beilenson said. If the program is successful, the city will expand the number of patients involved. One potential risk, Beilenson said, is that the program could exacerbate the problem of drug resistance by recruiting "unreliable" patients, such as drug users, who have proved "notoriously hard to keep in regularly therapy." Dr. Robert Redfield, a director of AIDS care at the University of Maryland Medical Center whom Beilenson credited with coming up with the idea for the program, said that a "key to success" will be to enroll people who are committed to taking their medication and will not have to be "coax[ed]." He added that patients who miss even 5% of their pills have a 20% chance of experiencing treatment failure. In addition, while DOT has proven successful in fighting tuberculosis, using the strategy against HIV "poses some heftier challenges." While TB drugs are usually taken twice a week for six months, HIV/AIDS drugs must be taken at least "twice a day for life." Dr. Gregory Lucas, an infectious disease specialist at Hopkins, said, "There is actually very little data on doing directly observed therapy for HIV. But the worst thing you can do for people is to give them their drugs and not have a consistent course of medical care" (Bor, Baltimore Sun, 11/13).