Baltimore Sun Profiles City Health Department Program That Monitors AIDS Patients’ Drug Administration

The Baltimore Sun yesterday profiled the Baltimore City Health Department's HIV/AIDS "directly observed therapy" program, which hand delivers medications to HIV/AIDS patients who are "unlikely" to stay on a treatment program if left unattended. The program, launched last year by city Health Commissioner Peter Beilenson and modeled after a "highly successful" tuberculosis control program in the 1970s, aims to prevent HIV-positive patients from developing drug-resistant HIV strains, which can be passed to others and "trigger a public health nightmare." City health workers visit program participants at their homes, at homeless shelters, at Narcotics Anonymous meetings or even on "pre-arranged" street corners, where the workers give the patients pre-packaged medications and listen to their problems, offer advice and sometimes drive patients to medical or psychiatric appointments. The health workers, who must have the "skills of a social worker" and the "know-how of a police officer," visit the patients, many of whom are drug users recruited directly from the city's needle-exchange program, the Sun reports. According to Michele Brown, the program director, there is no statistical evidence that the AIDS drug monitoring program is working, and the program cannot be expanded without proof of success. The Johns Hopkins Bloomberg School of Public Health is set to begin a study that will measure "how faithfully patients are taking medicines" and "how many are developing drug resistance." Dr. David Bangsberg, a physician who is testing a similar program in San Francisco, questioned how long the program can be sustained, given the cost and labor involved, adding that health agencies must find a way for patients to "graduate" and become self-sufficient (Bor, Baltimore Sun, 1/28).