A Family Approach to HIV Therapy

To realize the increased chances for survival that antiretroviral drugs (ARVs) promise, patients must follow a strict medication regimen for life. Jean Nachega, MD, MPH '99, an assistant scientist with the School's Department of International Health, is working with HIV-infected patients in Cape Town, South Africa to determine whether community-based, directly observed therapy (DOT) increases adherence to ARV treatment.

Traditional DOT therapy, in which a health clinic worker watches a patient take his or her medications to ensure compliance, has been highly effective in treating tuberculosis. In Nachega's study, funded by a three-year, $1.3 million NIH grant, patients select a close family member, friend or partner who lives with them to act as a "supporter." Their role is to ensure that the patient takes the twice-daily dosage of prescribed ARV medications.

"HIV is for life. You're not going to ask a patient to go to a clinic every day for his whole life," says Nachega, who recently received a $650,000 NIH Career Development Award to further his HIV research in sub-Saharan Africa.

The supporter will accompany the patient on monthly clinic visits for medication refills and tests, and will attend supporter education and discussion groups. Nachega theorizes that this approach could be a cost-effective alternative to conventional DOT strategy, and may be more suited to African society in which family relationships are paramount. "The idea is not to just observe the patient swallow the tablets," he says, "but to support the one you love and care about."

To assess the effectiveness of the intervention, Nachega and his research team will monitor 300 patients over three years for several clinical indicators, including adherence rate, CD4 counts, HIV-1 viral loads, the presence of drug-resistant viruses and the incidence of opportunistic infections. "The hope," he says, "is that having the supporter will establish taking medications as a routine part of daily life."