In Israel, highly active antiretroviral therapy is available (at local pharmacies) without cost. Nevertheless, poor adherence, especially of immigrants from Africa, leads to high rate of treatment failures. Our study looked whether direct monthly highly active antiretroviral therapy supply in our AIDS center has an effect on adherence and outcome.

A total of 385 HIV (clade C) immigrants from Africa that were treated with highly active antiretroviral therapy for >2 years prior to the initiation of the study were evaluated. During the first 2 years, highly active antiretroviral therapy medications were supplied by local pharmacies. Thereafter (next 2 years), all patients received medications, monthly at our center. Adherence, immunological (CD4) and virological (VL) outcome at the end of the two study periods were determined.

At baseline, only 75% of the patients attended more than 90% of scheduled visits with 57% treatment adherence. Virological failure (VL >40 copies/ml) was observed in 53% of the patients. As a result of our intervention (2 years of direct monthly highly active antiretroviral therapy supply), visits and treatment adherence significantly increased (90% and 84%, respectively; p < 0.001). Concomitantly, virological failure rate significantly dropped to 28% (p < 0.001).

Direct monthly supply of highly active antiretroviral therapy is a relatively low-cost mode to improve patient's adherence and immunological/virological outcomes.