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					Aurum Institute for Health
       Research
        Seminar

 DOT –An option for ART?
        Liesl Page-Shipp
       12 February 2007



                           managing HIV/AIDS and TB
Background
Close adherence to ART essential

Achieving and sustaining close adherence to
ART - major challenge to treatment
programmes

Should ART programmes follow the TB
model and give directly observed therapy
(DOT)
Objective
To investigate attitudes to DOT ART
 among gold miners in a workplace ART
 programme and to see whether these
 attitudes were affected by:

   Current experience of taking ART
   Previous TB DOT
   Attitudes to disclosure of HIV status
Method
Study design: Cross-sectional survey
Setting: Workplace HIV clinics for gold
miners in 2 regions in South Africa
Study population
  Clients receiving self-administered
   ART (>6 weeks) or
  undergoing pre-ART counseling
July to October 2003
Method
Consenting eligible clients enrolled
sequentially, total 50 per region

Semi-structured questionnaire
   Attitudes to
     DOT  ART
     TB DOT

     Disclosure of HIV status

   Current or expected experience of ART
Results-Demographics
100 clients enrolled
 61 already taking ART
 39 preparing to start

99% male, mean age 40.2 yrs
53% no more than primary education
78% live in single-sex hostels
71%had previous TB, most received
DOT in previous 5 years
Preference for DOT ART (n=100)

                           Yes
                           35%


               No
              65%


    “   I know why I am taking these tablets
         and it is better if they are with me”
         but 79% thought TB DOT good

        No difference between individuals on ART or
          those preparing to start
        Who should administer DOT?
Percentage agreeing




                                                                  60%           66%
                                                       34%
                       3%        11%        14%


                      friend   other ART     peer      family   HIV clinic    Primary
                                  client   educator   member                 Health Care
Attitude to DOT for TB drugs and
ART, by past history of TB
 100%
  90%
  80%
  70%
  60%                                     don't know
  50%                                     not good
  40%
                                          good
  30%
  20%
  10%
   0%

         DOT     DOT      DOT     DOT
        for TB for ART   for TB for ART

         Previous TB     No previous TB
           (N=71)          (N=29)
Reported disclosure of HIV status
       Percentage disclosed

                              100
                               90
                               80       30%
                               70
                               60                      79%        No
                               50                                 Yes
                               40
                               30       70%
                               20
                               10                      21%
                                0

                                    Disclosed to   Disclosed to
                                      partner       colleague
“for protection against infection and for them to
   test for HIV”
“she must know my status. No one will say we died
   of witchcraft”
Reasons given for not disclosing to
colleagues (n=71)

                          "my secret"
               4%   37%   "haven't thought about it"
          4%
                          fear of being talked
  20%
                          about/mocked
                          "my own illness"

                          no reason
  3%
                          other

        23%         9%
                          "they can't help"
Willingness to be a treatment
support for others (=n=100)

          No 22%




                          Yes 78%



“Because these tablets work and I am still
 alive”
Summary of results
65% not in favour of DOT ART
Not significantly related to:
 Demographics
 Current ART/other chronic medication
 Disclosure of status
 Previous TB

May be relation to
   Attitude to TB DOT
Conclusion
DOT ART not immediately popular
mostly because of desire to retain
control over their treatment

Clients indicated preference for DOT
from health care workers, possibly as
this is familiar model
Conclusion
Can TB programmes learn from ART
programmes?
 Counseling?
 Ownership?
 Convenient DOT?



Can ART programmes learn from TB
programmes?
Recommendations
If DOT ART were the usual method of
delivery, acceptability issues would
need to be addressed

Most clients willing to be treatment
supporters : peer support with/
without modified DOT might be an
acceptable model
Acknowledgements
Wellness clinic patients and staff

Clement Sefuthi, Isaac Mantsoe, Edwin
Magcuntsu, and Temba Moyake

Dr Alison Grant and Dr Salome
Charalambous

				
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