Directly Observed Therapy

Observed therapy has proven successful in helping to reduce HIV viral loads. This is critical to the prevention of transmission of HIV through pregnancy and delivery. DOT services are usually offered to patients with detectable viral loads over 1000 c/mL in the last trimester of their pregnancy.

MACA has provided direct observation assistance for pregnant women and their newborns since 2011.  

Observed therapy is a given during hospitalization. MACA provides DOT in the community. The program was developed to help support adherence by providing medication monitoring in the home. This is effective and costs far less than in-hospital DOT.

Observation in the home is provided by a peer, LPN or nurse worker. Moms may need help to remember to take medications during a complex pregnancy. A new mom may need additional support to give medications to her exposed newborn in the first few months of life.


  • Observation of medication adherence in the home
    • Once or twice daily, including weekends and holidays
    • Immediate follow up of missed doses
  • Standard protocol and policies developed
    • Signed commitment contract between all stakeholders
  • Weekly reporting of doses observed to clinical provider(s)
  • Peer or home health workers with different skill sets, as needed

FUNDING: A grant from IDPH provided funding for DOT (~400 hours annually) from 2014 through March of 2020.


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