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.

World Health Organization dimensions of adherence to antiretroviral therapy: A study at antiretroviral therapy centre, Aligarh

“…[ 15 18 23 ] Apart from the distance, none of socioeconomic factors were found to be significantly associated – which is in concordance with the various studies done in India, as most of these studies were done in similar centers getting free ART from NACO. [ 8 15 23 24 ] Among the therapy-related dimension, we found nonadherence to be significantly associated with (a) Drug-related side effect and (b) Efavirenz-combined therapy. This supports the findings of previous studies.…”

Retention in care and adherence to HIV and AIDS treatment in Anambra State Nigeria

“…Other studies have also reported different predictors of adherence to treatment in different populations and settings. Disclosure of HIV status [36, 37], education [36], duration on ART treatment [37] and alcohol use [36] have all been reported as predictors of adherence to treatment. These were not however elicited in this study.…”

Non-adherence to anti-retroviral therapy among HIV infected adults in Mon State of Myanmar

“…Patients in that study revealed numerous reasons for their actions, ranging from repoting being very busy to take their treatment to forgetfulness, drinking alcohol and substance use [ 12 ]. Moreover, a study in India reported that only 73% of patients on ART took their treatment with at least or over 95% adherence [ 13 ]. Furthermore, patients’ perceived erectile dysfunction may be regarded as a relevant problem for HIV-infected persons on anti-retroviral therapy [ 14 ] and has been strongly associated with suboptimal ART adherence [ 15 ].…”