ABSTRACT

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. (offsite PDF)

Background and objectives
Very high levels of adherence are required for ART to be effective. There is limited information available from India on adherence to ART and its predictors. We carried out this study to examine adherence levels and to explore the factors associated with adherence among PLHA receiving ART in India.

Methods
Using a cross-sectional study design, 310 HIV-positive patients receiving ART (252 paying out-of-pocket; 58 free via employee-insurance program) were interviewed from Pune and Delhi health facilities using a semi-structural questionnaire.

Results
The median age of patients was 36 years. The median time from diagnosis of HIV infection was 34.5 months, median time on ART was 16 months, and median CD4 cell count at start of ART was 110 cells/ml. Ninety-eight percent of the respondents were using a nonprotease inhibitor (PI) treatment regimen. Mean four-day adherence was 93 percent. Adherence was lower over longer periods of recall: 20 percent reported missed dose over the past seven days, 33 percent reported ever missing a full day’s medications, and 16 percent had a treatment interruption of more than seven days at least once. On univariate analysis, less than university education, being unemployed, obtaining free treatment, severe depression, baseline CD4 count >200/ml, hospitalization more than two times, having moderate to severe side effects, and taking four 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=0.009) and severe depression (adjusted OR 4.48, 95% CI 1.64–12.27, P=0.003) were associated with lower adherence in multivariate analysis.

Interpretation and conclusions
Although the 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 need special focus.

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