RESUMO
Background: Anti-retroviral therapy (ART) for HIV has changed a highly fatal disease to a chronic manageable condition. National technical guidelines by NACO say that adherence of >95%(optimal) is required for optimal viral load suppression which is a challenge both for the patient and the health system. Objectives: This study was conducted to determine the reasons for missed and lost to follow-up (LFU) cases and to assess the impact of the COVID pandemic on ART adherence. Settings and Design: Cross-sectional study conducted at ART center, Jhansi. Methods and Material: 357 patients were administered a self-designed questionnaire after taking informed consent to enquire about the reasons for missing doses and LFU and whether they missed treatment during the lockdown. Statistical analysis used: the results were expressed in frequencies and percentages and appropriate statistical tests were applied. Results: 72% HIV patients had optimal adherence and 6.7% were on second-line treatment. Out of 357 patients, 56 had missed treatment and 10 were LFU. The main reasons for the missing were run out of pills, busy with other things and being away from home. The number of episodes of missed and LFU increased during the pandemic. The main problems faced were lack of transport (24), fear of catching the disease (7), no money to hire a vehicle (5). Conclusions: Constant monitoring and handholding of those with suboptimal adherence is required. Travel allowance to such patients and regular counseling will help to ensure adherence. Long-term solutions include vocational rehabilitation and awareness programs to reduce stigma and discrimination.
RESUMO
Context: After introducing ‘Treat all policy’ in the country and free ART (Anti-retroviral therapy) for all patients the biggest challenge is to optimize adherence to therapy and ensure viral suppression. The present study is aimed to determine the adherence pattern of HIV positive patients at ART center, Jhansi in Uttar Pradesh and to determine the factors influencing adherence. Methods and Material: This cross-sectional study was conducted in an ART Centre of a teaching hospi-tal. In this study 357 patients were interviewed using a modified version of ACTG questionnaire and ad-herence was calculated by pill count and recall method. Chi square test and logistic regression was done using SPSS. Results: Nearly 72% patients had optimum adherence. On univariate analysis the factors found signifi-cant were sex of the patient, the education, the socioeconomic status, financial constraints, family sup-port, WHO stage at diagnosis, alcohol addiction and tobacco addiction. On logistic regression four factors, having less than college education, WHO stage IV at diagnosis, alcohol intake and lack of family support were found to be predictors of non-adherence. Conclusions: Family support, treatment of alcohol addiction improving education and job opportunities for these patients will improve adherence in HIV positive patients.