Cost of treatment: The single biggest obstacle to HIV/AIDS treatment adherence in lower-middle class patients in Mumbai, India

Abstract

Background:This study analyzes the social, economic and behavioral factors most frequently associated with adherence to Highly Active Antiretroviral Treatment (HAART) in urban India.Materials and Methods:Data was collected in a metropolitan teaching hospital in Mumbai using a cross-sectional survey design. Face-to-face interviews were conducted with 152 patients. The semistructured survey included both open and closed ended questions on socio-demographic, economic and behavioral factors. Factors affecting treatment adherence were analyzed.Results:The median age of patients was 40.5 years, 73% were males and all were heterosexual. Patients had been given ART from six months to five years (median is equal to 3.5). Ninety per cent lived at home and commuted to the clinic by bus or train. Behaviorally, 37% were sexually active, but only 55% used condoms. In assessing adherence, income, education, knowledge of their drugs, transportation, side effects, cost of treatment, distance from clinic and personal clinic satisfaction were analyzed. We found that 75% of patients reported cost of HAART to be the single greatest obstacle to adherence (p less than 0.01). Additionally, those claiming knowledge of their drugs were 2.3 times more likely to be adherent (p less than 0.03), while those who abused drugs or alcohol were 53% less likely to be adherent (p less than 0.03). There was no correlation with other factors.Conclusions:Our study population was representative of the lower middle class of India. It found that an educated, employed group considered the cost of treatment to be a significant obstacle for successful therapy. Additionally, it showed a significant increase in adherence when patients had knowledge of their HAART medications. Therefore, reducing the cost of medication as well as teaching about antiretroviral medications are both likely to improve adherence.

Adherence to antiretroviral therapy in India: A systematic review and meta-analysis

“…There were seven cross-sectional studies(11122122232425) and one retrospective chart analyses. (26) Three studies were conducted in southern India(212426) and two each in western(1225) and north India. (2223) One study enrolled participants from western and northern India.…”

“…showed a rate of 57%. (12) Therefore, the aim of this study is to systematically assess the rate of ART adherence across all studies conducted in India and the reasons for non-adherence (if any). We have performed a systematic review and metaanalysis to provide conclusive data on ART adherence in HIV/AIDS patients in India.…”

Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

“…The current evidence has primarily centered on HIV-infected adults, and suggests several mechanisms for why this may be the case. HIV-infected individuals may have inadequate economic access to ART, limiting resources to pay for real or perceived costs related to medications and treatment, including travel costs to remain engaged in care [15–17]. Many individuals living with HIV, including families affected by AIDS, may have lost employment or other sources of income over the course of their illness.…”

Perceptions regarding barriers and facilitators to combination antiretroviral therapy adherence among people living with HIV/AIDS in Gujarat, India: A qualitative study

“…Similarly cART adherence studies by Kumarasamy et al , Naik et al and Wanchu et al conducted in India also showed the association of high cost of cART as a barrier to cART adherence. [91213] However, patients taking cART from private practitioners generally still find cost as a major barrier for cART. One study by Sarna et al .…”