Barriers to ART adherence &amp; follow ups among patients attending ART centres in Maharashtra, India

Joglekar, Neelam; Paranjape, Ramesh; Jain, Radhika; Rahane, Girish; Potdar, Ratnaprabha R.; Reddy, K. Srikanth; Sahay, Seema

doi:10.4103/0971-5916.92642

Cited by 38 publications

(19 citation statements)

References 15 publications

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“…Social support has been associated with higher adherence (Nyamathi et al, 2012; Shah et al, 2007), and depression is linked with poorer adherence (Anuradha et al, 2013; Nyamathi et al, 2012; Sarna et al, 2008). Although stigma has been associated with poor adherence in many settings (Kingori et al, 2012; Rao, Kekwaletswe, Hosek, Martinez, & Rodriguez, 2007; Rintamaki, Davis, Skripkauskas, Bennett, & Wolf, 2006; Vyankandondera et al, 2013) and noted as a barrier in qualitative studies (Joglekar et al, 2011; Kumarasamy et al, 2005), it has not been quantitatively assessed in India.…”

Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy adherence measurement in non-clinical settings in South India

et al. 2014

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Optimal adherence to antiretroviral therapy (ART) is key to viral suppression, but may be impeded by psychosocial consequences of HIV-infection such as stigma and depression. Measures of adherence in India have been examined in clinic populations, but little is known about the performance of these measures outside clinical settings. We conducted a cross-sectional study of 151 Tamil-speaking people living with HIV/AIDS (PLHA) in India recruited through HIV support networks and compared single item measures from the Adult AIDS Clinical Trial Group (AACTG) scale, a visual analog scale (VAS), and a question on timing of last missed dose. Depression was measured using the Major Depression Inventory (MDI) and HIV-related stigma was measured using an adaptation of the Berger Stigma Scale. Mean age was 35.6 years (SD±5.9); 55.6% were male; mean MDI score was 11.9 (SD±9.1); and mean stigma score was 67.3 (SD±12.0). Self-reported perfect adherence (no missed doses) was 93.3% using the AACTG item, 87.1% using last missed dose, and 83.8% using the VAS. The measures had moderate agreement with each other (kappa 0.45 - 0.57). Depression was associated with lower adherence irrespective of adherence measure used, and remained significantly associated in multivariable analyses adjusting for age and marital status. Stigma was not associated with adherence irrespective of the measure used. The VAS captured the greatest number of potentially non-adherent individuals and may be useful for identifying PLHA in need of adherence support. Given the consistent and strong association between poorer adherence and depression, programs that jointly address adherence and mental health for PLHA in India may be more effective than programs targeting only one.

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Section: Introductionmentioning

confidence: 99%

Antiretroviral therapy adherence measurement in non-clinical settings in South India

et al. 2014

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“…With respect to other studies that show that the presence of family may promote nonadherence (Joglekar et al, 2011;Sharma, Khadga, Dhungana, & Chitrakar, 2013), the fact that one participant in this study noted the opposite is noteworthy. As Jadidi and Nakhaee (2014) assert, substance abuse can be promoted by one's peers as their association together yields more opportunities to engage in the behaviour (Jadidi & Nakhaee, 2014).…”

Section: Psychological Supportcontrasting

confidence: 41%

'Experience talks, resilience shapes' revisiting historic trauma: impact on treatment in indigenous males living with HIV/AIDS in British Columbia

Chongo¹

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There is an over-representation of HIV incidence, prevalence and mortality rates in the Indigenous population of Canada. Further, many do not adhere to HAART partly because of unresolved historic trauma (HT). Most research on HIV/AIDS therapy has focused on "maladaptive" characteristics of Aboriginal males and less on their adaptive, life-maintaining practices.This study explored the impact of HT on treatment among Indigenous males living with HIV/AIDS in BC, with a focus on adaptive/life maintaining practices, i.e., how the experience of HT positively affects male survivors' ability to adhere to treatment, and the HT impact on treatment outcomes across age groups and residential school survivor status.Using interpretive description incorporating a cultural safety lens as the methodological framework, data was collected through one-to-one interviews, a focus group, and a few Life Story Board sessions. Thirty-six HT survivors told their lived experience stories, discussed how HT affected their adherence to HAART, and explained how they build resilience.Three main themes resulted from data analysis: 1) facilitators of choice or actions leading to HAART adherence; 2) factors leading to HAART non-adherence; and 3) comparative survivor responses on health, services, stigma and the historic trauma effect.Adherence choices and actions are promoted by psychological support, cultural services, religion and spirituality, structural services, resilience, strictness and discipline metered on indirect survivors through their parents. Negative choice or actions resulted from; personal reasons, cultural restrictiveness, lack of structural support and services, spiritual and religionrelated factors, and intergenerational historic trauma effects. Finally, comparative responses of survivors' views noted included the view of health with respect to resilience, availability of and access to services on-and off-reserve, stigma and confidentiality, and the effect of historic iii trauma through generations and across survivor status. The findings demonstrate how complex the experience and expression of HT is and that most Indigenous men can be resilient to stay on HAART and have better health and wellbeing.Cultural-safety informed recommendations are offered to better address HT, improve treatment-adherent behaviour and resilience, foster healing and reduce deaths due to HIV/AIDS. This study suggests promising resilience factors that have implications for both research and practice.iv

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“…A systematic review by Govindasamy et al (2014) found several other interventions to be effective in facilitating linkage in LMICs including integration of care and point-of-care CD4 count. Moreover, while not addressed in this study, discrimination by healthcare providers, threat of jail, or criminal prosecution, as well as travel or waiting time, could be additional barriers for MSM and PWID in accessing appropriate HIV-related health care (Chakrapani et al, 2011, 2014; Joglekar et al, 2011). …”

Section: Discussionmentioning

confidence: 99%

Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India

et al. 2016

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UNAIDS set an ambitious target of “90-90-90” by 2020. The first 90 being 90% of those HIV-infected will be diagnosed; the second 90 being 90% of those diagnosed will be linked to medical care and on antiretroviral therapy (ART). While there has been dramatic improvement in HIV testing and ART use, substantial losses continue to occur at linkage-to-care following HIV diagnosis. Data on linkage among men who have sex with men (MSM) and people who inject drugs (PWID) are sparse, despite a greater burden of HIV in these populations. This cross-sectional study was conducted in 27 sites across India. Participants were recruited using respondent-driven sampling and had to be ≥18 years and self-identify as male and report sex with a man in the prior year (MSM) or injection drug use in the prior 2 years (PWID). Analyses were restricted to HIV-infected persons aware of their status. Linkage was defined as ever visiting a doctor for management of HIV after diagnosis. We explored factors that discriminated between those linked and not linked to care using multi-level logistic regression and area under the receiver operating curves (AUC), focusing on modifiable factors. Of 1726 HIV-infected persons aware of their status, 80% were linked to care. Modifiable factors around the time of diagnosis that best discriminated linkage included receiving assistance with HIV medical care (odds ratio [OR]: 10.0, 95% confidence interval [CI]): 5.6–18.2), disclosure of HIV-positive status (OR: 2.8; 95% CI: 2.4–6.1) and receiving information and counseling on management of HIV (OR: 2.3; 95% CI: 1.1–4.6). The AUC for these three factors together was 0.85, higher than other combinations of factors. We identified three simple modifiable factors around the time of diagnosis that could facilitate linkage to care among MSM and PWID in low- and middle-income countries to achieve UNAIDS targets.

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Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India

Cited by 38 publications

References 15 publications

Antiretroviral therapy adherence measurement in non-clinical settings in South India

Antiretroviral therapy adherence measurement in non-clinical settings in South India

'Experience talks, resilience shapes' revisiting historic trauma: impact on treatment in indigenous males living with HIV/AIDS in British Columbia

Getting to 90: linkage to HIV care among men who have sex with men and people who inject drugs in India

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