Adherence to anti-retroviral therapy & factors associated with it: a community based cross-sectional study from West Bengal, India.

ABSTRACT

Background & objectives: Failure to adhere to anti-retroviral therapy (ART) can lead to a range of unfavourable consequences impacting upon people living with HIV (PLH) and society. It is, therefore, paramount that ART adherence is measured in a reliable manner and factors associated with adherence are identified. Lack of such data from West Bengal necessitated undertaking the current study. Methods: Participants were included during August-October, 2011 from three Drop-In-Centres (DICs) from the three districts of West Bengal, India. ART-adherence was calculated by using formula based on pill-count and records collected from ART-card in possession of each of the 128 consenting adult PLH. Information on self-reported adherence, socio-demography, and adherence influencing issues was also collected through interviewer-administered questionnaire. Results: Of the 128 PLH, 99 (77%) and 93 (73%) PLH had ≥90 per cent and ≥95 per cent adherence, respectively to ART. Conversely, subjective reporting captured much higher proportion of PLH as ‘well adherent’; a finding having implications for ongoing ART programme. Factors, independently associated with poor adherence (<90%), were ‘7th to 12th month period of ART intake’ (adjusted OR=9.5; 90% CI 1.9 - 47.3; p=0.02) and ‘non-disclosure of HIV status to family members’ (adjusted OR=4; 90% CI 1.3 - 13; p=0.05. Results at 95 per cent adherence cut-off were similar. Interpretation & conclusions: Enabling environment, which would encourage people to disclose their HIV status and in turn seek adherence partners from families and beyond and ongoing adherence-counselling appear to be important issues in the programme. Relevance of these study findings in wider context is conceivable.