HomeIntermittent therapy (ie, regimens that include doses taken 3 times per week) should only be used in combination with DOT.1,2 If therapy is self-administered, intermittent therapy should not be used, and drugs should be administered daily. Findings from a recent systematic review and meta-analysis of randomized controlled trials of people receiving standard first-line therapy demonstrated higher rates of failure, relapse and acquired drug resistance in people taking medications thrice weekly throughout therapy, including during the intensive phase.3 For intermittent therapy in the continuation phase, twice-weekly therapy was associated with higher rates of failure and relapse. Thrice-weekly intermittent therapy in the continuation phase was associated with a non-significant increase in relapse in pooled analysis, which was not demonstrated in the meta-regression results.3
Recommendations
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We strongly recommend against rifampin-containing regimens given thrice weekly throughout therapy, as they are associated with higher rates of failure, relapse and acquired drug resistance (good evidence).
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We strongly recommend against rifampin-containing regimens given daily in the intensive phase then twice weekly in the continuation phase, as they are associated with higher rates of failure and likely relapse (good evidence).
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We conditionally recommend that thrice-weekly therapy be used in the continuation phase if daily therapy is not feasible, and the person is not living with HIV. Directly observed therapy must be used with this regimen and it may be associated with higher rates of relapse (poor evidence).
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