Horizons Projects | Examining Adherence to Treatment and Sexual Risk Behavior among Patients Receiving Antiretroviral Therapy (ART) in India: A Diagnostic Study

HORIZONS PROJECT
Examining Adherence to Treatment and Sexual Risk Behavior Among Patients Receiving Antiretroviral Therapy in India: A Diagnostic Study

Very high levels of patient adherence are required for antiretroviral therapy (ART) to be effective and to prevent the emergence of resistant HIV strains. While antiretrovirals (ARVs) have been available in India since 1997, very little information is available on the levels of adherence to ART among people living with HIV and AIDS in India. In addition, optimism related to ART’s success in slowing disease progression, reducing viral load, and improving health status may lead to more risky sexual practices.

To meet these knowledge gaps and better understand the sexual risk behavior of patients on ART, Horizons and research partners conducted a study to assess current levels of adherence to ART among a sample of people living with HIV and AIDS, identify factors that influence their adherence to treatment, and determine their sexual risk behaviors.

Three hundred ten HIV-positive patients currently on ART and attending one private and three public-sector health facilities in Delhi and Pune were interviewed between May and August 2004, using a semi-structured questionnaire.

Key findings include:

The mean four-day adherence was high in this population; however, adherence decreased over longer recall periods.
Severe depression and obtaining free ARVs through insurance programs were the main predictors of lower adherence.
Lower adherence was documented among patients receiving free ARVs, even after controlling for economic status.
For clients with no insurance coverage, being on ART is a heavy economic burden and most would switch to a free program, if available.
Most respondents reported being sexually active in the past six months, primarily with a regular partner.
Reported condom use was high with regular partners.

Location

Pune and New Delhi, India

Duration

January 2004–June 2005

Horizons and Population Council researchers

Avina Sarna

Non-Council collaborators

Indrani Gupta (Institute of Economic Growth)

Sanjay Pujari (Ruby Hall Clinic)

A.K. Sengar, Amita Rawal (Northern Railway Hospital)

Rajiv Garg (Employees' State Insurance Corporation)

Sanjay Katke, Nilofer Shaikh, Sheetal Sorabia, Milli Barua, Sandeep Rasapulkar, Pauline Gomes, Mrudul Patil (consultants)

Donors

US Agency for International Development

Publications/Resources
Horizons and Population Council researchers' names appear in boldface type.

2008
Sarna, Avina, Sanjay Pujari, A.K. Sengar, Rajiv Garg, Indrani Gupta, and Johannes van Dam. 2008. “Adherence to antiretroviral therapy and its determinants amongst HIV patients in India,” Indian Journal of Medical Research 127(1): 28–36. (abstract)

2006
Sarna, Avina, Indrani Gupta, Sanjay Pujari, A.K. Sengar, Rajiv Garg, and Ellen Weiss. “Examining adherence and sexual behavior among patients on antiretroviral therapy in India,” Horizons Final Report. Washington, DC: Population Council. (PDF)

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