One-stop shopping for injecting drug users?
One-stop shopping for injecting drug users?
Injection drug users' compliance with their prescribed antiretroviral therapies would be improved greatly if the patients were given directly observed therapy (DOT), as is currently done for tuberculosis patients at Johns Hopkins and other institutions to ensure compliance with medications.
"It would be one-stop shopping," says Steffanie A. Strathdee, PhD, associate professor of epidemiology at Johns Hopkins University and lead investigator of a study on therapy compliance. "Someone would go in to get [his or her] methadone dose for the day, and they'd receive their antiretroviral pills for the day."
She says such programs are currently in place in Amsterdam, where all aspects of caring for IDUs are provided in one program - needle exchange, ART, rehab for substance abuse, and other health care.
"It's very unrealistic for us to expect that drug users are going to go to 20 different places to get their health care needs met," Strathdee adds. "What we've got to do is synchronize our efforts and make it all under one roof, or at least under one administrative structure. That's going to take a change in philosophy, and a change in the way we deliver health care to needy people."
Renslow Sherer, director of the Cook County (IL) HIV Primary Care Center in Chicago, agrees. "I think we have absolutely compelling evidence that we can reduce mortality and morbidity [with DOT]," he says. "So it's going to be cost-effective in the same way that it's cost-effective with tuberculosis to actually use the existing health infrastructure to take whatever percentage of patients [are IDUs] and actually set up structures for them to be observed, such as in a methadone maintenance clinic. It's not such a reach to think about doing [drug therapy] in an integrated way."
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