To minimize nursing burden, all DOT medications are prepared in advance in individualized pill trays.
Pill trays are labeled by research assistants and filled by centralized DoSA pharmacists.
Ribavirin pill counts are performed of unconsumed pills in the pill trays in the mDOT arm and in the ribavirin bottle in the TAU arm.
Since ribavirin is prescribed twice daily, we utilize two pill trays: one containing the morning doses (usually 2-3 candules) and one containing the evening doses (usually 2-3 capsules).
Pill trays are delivered from the centralized DoSA pharmacy to the individual methadone clinics every two weeks, along with scheduled methadone deliveries.
Preparing pill trays for use in the mDOT intervention requires communication between the trial's Medical Director, research staff, HCV treatment providers, nurses, community pharmacies, and centralized DoSA pharmacists.
Upon enrollment in the study, each participant was sent a videophone (see Figure 1) and a "pill counting tray" (see Figure 2).
Next a technician loads the pills onto the tray of a Pentapack machine, which packages each one into a blister and stacks them within long, rectangular tubes.
Chrome plated spill tray.
Within days, operating room lights, examination tables, medicine cabinets, adjustable tray tables, pill dispensers, medical carts, stools, bunk beds, chairs, and other equipment -- including two full-size nursing stations and a $1.2 million CT scanner -- begin to make their way into 40-foot containers.
