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To the Editor: Highly active antiretroviral therapy (HAART) has been shown to decrease mortality and morbidity in persons infected with human immunodeficiency virus, but adherence to the regimen is essential to a successful outcome.^1-2 With the widespread use of protease inhibitors, directly observed therapy (DOT) with these medications has been proposed.^3-5 This strategy has proven successful in enhancing medication adherence among marginalized populations with tuberculosis.⁶

Methods

We have developed a pilot program of modified DOT (MDOT) for individuals receiving antiretroviral therapy. All participants were recruited from the Miriam Hospital Immunology Center in Providence, RI, and were referred by their treating physician due to self-reported nonadherence. A "near-peer" outreach worker delivers medication 5 days a week at a place and time determined by the participant. The outreach worker observes the patient taking the morning dose, but not those on evenings or weekends. During each visit, the worker records adherence to unobserved doses . . . [Full Text of this Article]