Retention in pre-antiretroviral treatment care in a district of Karnataka, India: how well are we doing?

Shankar, Dhananjay; Kumar, Ajay M. V.; Rewari, B. B.; Kumar, Suhas; Shastri, Suresh; Satyanarayana, Srinath; Ananthakrishnan, Ramya; Nagaraja, Sharath Burugina; Devi, Monisha; Bhargava, N.; Das, Mrinalini; Zachariah, Rony

doi:10.5588/pha.14.0073

Cited by 8 publications

(9 citation statements)

References 20 publications

(21 reference statements)

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“…33 Delay in initiation of cART after diagnosis is known to be associated with patients being lost to follow-up with delayed presentation for treatment at a later date. 33,34 We analyzed patient data at the initiation of cART and not at entry into HIV care at diagnosis. In May 2017, NACO implemented a change in HIV treatment guideline to treat all individuals with HIV irrespective of CD4 count.…”

Section: Discussionmentioning

confidence: 99%

Correlates of Late Presentation to HIV care in a South Indian Cohort

Rao

Unnikrishnan

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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Late presentation to healthcare by HIV infected patients' is common in India despite access to free combination antiretroviral therapy (cART). We assessed risk factors for late presentation among patients with a recent HIV diagnosis in an academic university-based antiretroviral treatment center. This retrospective study included 474 recently diagnosed HIV-infected patients registered for cART between 2012 and 2013. Subjects with CD4 T-lymphocyte (CD4) count ≤ 350 cells/μL or with an AIDS defining event were defined as late presenters (LP) and patients with CD4 count ≤ 200 cells/μL or with an AIDS defining event were defined as LP with advanced HIV disease (LPAD). Multivariable logistic regression analysis was used to investigate factors associated with late presentation. Of the 474 patients, 356 (75.1%) were LP. Of these, 299 (83.99%) were LPAD and 57 (16.01%) LP were AIDS-free. Median CD4 count among LP was 134 cells/μL (interquartile range 72.25-219). Mean age of LP was 42.50 ± 8.88 years; 256 (71.9%) were males. Increasing age (> 51 years; Adjusted odds ratio [aOR] 4.19; = 0.014) and rural residence (aOR 3.19; = < 0.001) were independently associated with late presentation. HIV-positive housewives (aOR 0.34; = 0.027), HIV-positive individuals with negative partners (aOR 0.48; = 0.006), and partners with unknown HIV status (aOR 0.43; = 0.007) were less likely to present late compared with positive partners of people living with HIV/AIDS (PLWHA). Most patients were LP despite free access to cART. Rural population and older PLWHA should be targeted while implementing HIV care. There is a need to strengthen the HIV care cascade by linking PLWHA to cART immediately after diagnosis.

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Section: Discussionmentioning

confidence: 99%

Correlates of Late Presentation to HIV care in a South Indian Cohort

Rao

Unnikrishnan

et al. 2018

The American Journal of Tropical Medicine and Hygiene

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“…12 In a cohort of PLHIV attending a public ART center in Karnataka between 2010 and 2012, factors associated with loss to care at 12 months included age greater than 45 years, low educational level, being unmarried, rural residence, and advanced World Health Organization stage disease. 13 Improving our understanding of the factors that contribute to loss to HIV care in the current era of "Test and Treat" in India would help identify PLHIV at risk for loss to care and who would potentially benefit from interventions to keep them in care and virologically suppressed. To help fill this knowledge gap, we conducted a qualitative study at a large, private ART care center in southern India to identify the factors contributing to loss to HIV care in India.…”

Section: Introductionmentioning

confidence: 99%

The Convergence of Disclosure Concerns and Poverty Contributes to Loss to HIV Care in India: A Qualitative Study

Perlo

Colocci

Rajagopal

et al. 2020

J Int Assoc Provid AIDS Care

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In India, there is little evidence on reasons for high rates of loss to HIV care. We conducted a clinic-based qualitative study at the YR Gaitonde Centre for AIDS Research and Education to explore factors that influence loss to care. In all, 17 men and 14 women were interviewed; median age was 42 (interquartile range [IQR], 36-48) and median CD4 count was 448 (IQR, 163-609). A majority reported avoiding treatment freely available at nearby government facilities because of disclosure concerns and perceptions of poor quality. As a result, participants sought care in the private sector where they were subjected to medication and transport costs. Life circumstances causing lost wages or unexpected expenditures therefore prevented participants from attending clinic, resulting in loss to care. Improving perceptions of quality of care in the public sector, addressing disclosure concerns, and reducing economic hardships among people living with HIV may be important in reducing loss to HIV care in India.

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“…[2][3][4] Previously published studies from India have confirmed these findings: about 20-26% of diagnosed PLHIV are lost before being registered at the ART centres, while 40-80% of ART-ineligible PLHIV are lost after registration at ART centres during pre-ART care. [5][6][7][8][9] There is no published evidence in India as to what proportion of ART-eligible PLHIV are lost before initiating ART. Analysis of routinely reported aggregate data from the National AIDS (acquired immune-deficiency syndrome) Control Programme (NACP) in the state of Gujarat, India, indicates that the gap between the number of people eligible for ART initiation and the number actually initiated on ART was approximately 12% in 2014-2015.…”

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confidence: 99%

“…13,14 These factors tend to be context-specific, however, and there are challenges in generalising them to the national situation in India. While previous publications from India have quantitatively assessed the factors associated with pre-ART attrition among ART-ineligible PLHIV, [5][6][7][8] they have not provided insights into the reasons for attrition, which require qualitative study. 6,7 We therefore aimed to quantify, among PLHIV enrolled for care in two districts of Gujarat, the gap between being recorded as eligible for ART and initiation on ART within 2 months of eligibility, and to assess the factors (both quantitatively and qualitatively) associated with non-initiation.…”

mentioning

confidence: 99%

“…While previous publications from India have quantitatively assessed the factors associated with pre-ART attrition among ART-ineligible PLHIV, [5][6][7][8] they have not provided insights into the reasons for attrition, which require qualitative study. 6,7 We therefore aimed to quantify, among PLHIV enrolled for care in two districts of Gujarat, the gap between being recorded as eligible for ART and initiation on ART within 2 months of eligibility, and to assess the factors (both quantitatively and qualitatively) associated with non-initiation. The specific objectives were 1) to determine the number (proportion) not started on ART within 2 months among PLHIV eligible for ART at enrolment; 2) to assess the demographic and clinical factors associated with non-initiation of ART; and 3) to understand the perceived reasons for non-initiation of ART and explore suggestions for addressing non-initiation from the perspective of the providers.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Why are HIV-infected people not started on antiretroviral therapy? A mixed-methods study from Gujarat, India

2018

Indian Journal of Tuberculosis

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Five purposively selected antiretroviral therapy (ART) centres in Gujarat, India. Objectives: To assess the proportion of ART-eligible people living with the human immunodeficiency virus (PLHIV) who were not initiated on ART within 2 months of being recorded as eligible, to identify factors associated with non-initiation and to explore reasons from the provider's perspective. Design: We used a mixed-methods design (triangulation) of 1) a quantitative phase involving record reviews and cohort analysis (Poisson regression) of PLHIV registered during April 2014-March 2015, and 2) a qualitative phase involving one-to-one interviews with 25 providers. Results: Of 2079 ART-eligible PLHIV, 339 (16%) were not started on ART within 2 months. PLHIV with CD4 counts of <350 cells/μl and patients who were labourers, hospitalised, bedridden or registered with certain ART centres were more likely not to be initiated on ART. Qualitative results were categorised into two broad themes: government health system-and patient-related challenges, which validated and complemented the quantitative findings. Conclusion: Several patient subgroups at greater risk of ART non-initiation were identified, along with reasons for risk; this has important programme implications for achieving the UNAIDS 90-90-90 goal, and particularly the second 90 component of having 90% of diagnosed PLHIV start ART.

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Retention in pre-antiretroviral treatment care in a district of Karnataka, India: how well are we doing?

Cited by 8 publications

References 20 publications

Correlates of Late Presentation to HIV care in a South Indian Cohort

Correlates of Late Presentation to HIV care in a South Indian Cohort

The Convergence of Disclosure Concerns and Poverty Contributes to Loss to HIV Care in India: A Qualitative Study

Why are HIV-infected people not started on antiretroviral therapy? A mixed-methods study from Gujarat, India

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