Journal Article

Adherence to Antiretroviral Therapy and Virologic Suppression among HIV-Infected Persons Receiving Care in Private Clinics in Mumbai, India

Bijal Shah, Louise Walshe, Dattary G. Saple, Shruti H. Mehta, Jeetender P. Ramnani, R. D. Kharkar, Robert C. Bollinger and Amita Gupta

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 44, issue 9, pages 1235-1244
Published in print May 2007 | ISSN: 1058-4838
Published online May 2007 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/513429
Adherence to Antiretroviral Therapy and Virologic Suppression among HIV-Infected Persons Receiving Care in Private Clinics in Mumbai, India

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Background. Adherence to antiretroviral therapy (ART) and correlates of adherence and virologic suppression among human immunodeficiency virus (HIV)—infected persons receiving ART in private, outpatient clinics in India is unknown.

Methods. Between December 2004 and April 2005, persons receiving ART at 3 private clinics in Mumbai, India, were interviewed regarding HIV care and adherence to ART. Physicians also completed a survey for each participant. Quantitative HIV-1 RNA level was determined for 200 participants.

Results. Of 279 participants, 73% reported ⩾95% adherence to ART. Adherence was positively associated with age ⩾50 years (adjusted odds ratio [aOR], 3.90), presence of comorbid conditions (aOR, 1.92), medication self-efficacy (aOR, 4.01), absence of pain in the past month (aOR, 2.14), and support from family and friends (aOR, 2.57). Lack of reminders from family members to take medication (aOR, 0.27) was negatively associated with adherence. Of 200 participants, 127 (63.5%) had virologic suppression (RNA level, <400 copies/mL). Independent correlates of suppression were a regimen containing ⩾3 ART drugs (aOR, 5.52), first ART regimen (aOR, 3.28), adherence to therapy ⩾95% (aOR, 5.70), female sex (aOR, 3.19), and a physical component score ⩾50 (aOR, 1.07).

Conclusion. Self-reported adherence to ART in a sample of patients attending Mumbai's private clinics was relatively high. However, the fact that a detectable viral level was found in nearly 40% of patients suggests that second-line ART regimens, as well as an emphasis on adherence and appropriate ART regimens in India, is needed.

Journal Article.  4637 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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