Methods: Clients in Los Angeles County were randomized to participate for six months in one of three antiretroviral adherence program arms: 1) Directly Administered Antiretroviral Therapy (DAART) in which a community worker delivered antiretrovirals to their home each weekday, 2) Intensive Adherence Support Program (IAP) in which they received counseling on adherence during a weekly visit with a case manager, and 3) Standard of Care (SOC). Health care utilization was assessed from date of study enrollment (November 2001 - March 2004) through Oct. 31, 2004. We analyzed differences between SOC and each intervention group for number of hospitalizations, hospital days, outpatient visits and emergency department visits, using a Bonferroni-corrected alpha of 0.025 for multiple hypothesis tests to retain a 0.05 overall level of statistical significance.

Results: 250 persons were randomized into the study: DAART (n=82), IAP (n=84) and SOC (n=84); observation-days averaged 632, 646 and 615 days, respectively. The number of outpatient visits was 43.3, 36.5 and 31.1 per 1,000 person-days, respectively, (p<0.025 for DAART vs SOC and IAP vs SOC). The number of hospitalizations was 0.8, 0.6 and 0.9 per 1,000 person-days, respectively, (no significant differences between SOC and other groups). The number of hospital days was 5.0, 2.3 and 7.4 per 1,000 person-days (p<0.025 DAART vs SOC and IAP vs SOC). The number of emergency department visits was 0.7, 0.5 and 0.7 per 1,000 person-days, respectively (no statistically significant differences between groups).

Conclusions: Both antiretroviral adherence programs were associated with increased outpatient visits and reduced hospital days, indicating that clients in these programs may be more likely to receive ongoing monitoring and outpatient care resulting in shorter hospitalizations.