Adherence to antiretroviral therapy and its determinants amongst HIV patients in India (PDF)
Sarna,Avina; Pujari,Sanjay; Sengar,A.K.; Garg,Rajiv; Gupta,Indrani; van Dam,C.Johannes
Indian Journal of Medical Research 127(1): 28-36
Publication date: 2008
Background and objectives
Very high levels of adherence are required for ART to be effective. This study examines adherence levels and explores the factors associated with adherence among PLHA receiving ART in India.
Using a cross-sectional study design 310 HIV+ patients receiving ART (252 paying out-of-pocket; 58 free via employee-insurance program) were interviewed.
Median time from diagnosis of HIV-infection was 35-months, median time on ART was 16-months and median CD4 cell count at start of ART was 110cells/mm. Ninety-eight percent of the respondents were using a non-PI treatment regimen. Mean 4-day adherence was 93 percent. Adherence was lower over longer periods of recall: 20 percent reported missed does over the past 7 days; 33 percent reported ever missing a full day's medications and 16 percent had a treatment interruption of more than 7-days at least once.On univariate analysis less than university education, being unemployed, obtaining free treatment, severe depression, baseline CD4 count>200/mm, hospitalization >2times, having moderate to severe side-effects and taking 4 or more medicines were associated with lower adherence (<90%). However, only obtaining free treatment (adjusted OR, 4.05, 95% CI 1.42-11.54, p.009) and severe depression (adjusted OR 4.48, 95% CI 1.69-12.26, p.003) were associated with lower adherence in multivariate analysis.
Interpretation and conclusions
Although overall adherence was high, lower levels of adherence were documented among patients receiving free ART. Provision of free treatment without adequate patient preparation and adherence support may compromise the success of ART scale up programs. Early diagnosis and management of depression needs special focus.