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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3181fcbcc9
Erratum

Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review: Erratum

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The article by Hart et al, appearing in JAIDS: Journal of Acquired Immune Deficiency Syndromes, Vol 54, No. 2, pp. 167-179 entitled “Effect of Directly Observed Therapy for Highly Active Antiretroviral Therapy on Virologic, Immunologic, and Adherence Outcomes: A Meta-Analysis and Systematic Review,” contains corrected results which are now being reported. Firstly, the authors conducted their meta-analysis with incorrect numbers for the virologic outcomes for Arnsten et al.'s randomized clinical trial. In the published manuscript, they reported a significant pooled effect of DOT-HAART on virologic suppression, with a random effects (RE) risk ratio of 1.24 (95% CI of 1.08, 1.41). The correct pooled effect on virologic outcomes is a RE risk ratio of 1.29, with a 95% CI of 1.12, 1.48 (see Figure). Meta-regression analysis (shown in the Table) also yields different results for the following stratifications: intervention effect on virologic suppression is now significant for interventions carried out in methadone clinics (RE risk ratio 1.87, 95% CI 1.61, 2.16) and for those DOT-HAART studies which were randomized controlled trials (RE risk ratio of 1.26, 95% CI 1.04, 1.52). DOT-HAART impact for several subcategories was already reported to be significant, but now demonstrates stronger intervention effect: enhanced DOT-HAART interventions, those conducted in resource-rich settings, interventions targeting HAART-experienced patients, and those for substance users.

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Table 1
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Upon stratification, intervention effect among RCTs now reaches significance, whereas results in the prior report were of marginal significance (risk ratio of 1.18, 95% CI 0.99, 1.42). Perhaps most importantly, these corrected findings further strengthen the argument that DOT-HAART is an effective intervention for high-risk populations, particularly substance users and HAART-experienced individuals. Furthermore, the design of the intervention is likely an important determinant of effectiveness: both enhanced DOT (i.e. DOT-HAART delivered with additional “wrap-around” services”) and DOT delivered at a place of convenience for the client, such as a methadone clinic, reflect a philosophy of comprehensive patient-centered care, likely a key “ingredient” of effective DOT-HAART programs.

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REFERENCE

1. Hart JE, Jeon CY, Ivers LC, et al. Effect of directly observed therapy for highly active antiretroviral therapy on virologic, immunologic, and adherence outcomes: a meta-analysis and systematic review. J Acquir Immune Defic Syndr. 2010;54(2):167-179.

© 2011 Lippincott Williams & Wilkins, Inc.

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