Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India.

ABSTRACT

Background & objectives: National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV. Methods: Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them. Results: sSuboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR-1.341, CI-1.080-1.665) , on ART for less than 6 months (OR-1.540, CI- 1.280-1.853), male gender (OR for females -0.807, CI- 0.662-0.982), tribals (OR-2.246, CI-1.134-4.447), on efavirenz (EFA) regimen (OR- 1.479, CI - 1.190 - 1.837), presence of anxiety (OR- 1.375, CI - 1.117 - 1.692), non-disclosure of HIV status to family (OR- 1.549, CI - 1.176 - 2.039), not motivated for treatment (OR- 1.389, CI - 1.093 - 1.756), neglect from friends (OR-1.368, CI-1.069-1.751), frequent change of residence (OR- 3.373, CI - 2.659 - 4.278), travel expenses (OR- 1.364, CI - 1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR-1.639, CI-1.330-2.019). Interpretation & conclusions: To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.