title: Knowledge, attitudes, and practices of antiretroviral therapy among HIV-infected adults attending private and public clinics in India.
abstract: India has approximately 5.2 million persons infected with HIV. Although antiretroviral therapy (ART) is being widely introduced in public clinics, many HIV-infected persons still seek care via the private sector. A cross-sectional survey was conducted in 2004 at six public and private sites to characterize the knowledge, attitudes, and practices (KAP) of ART among patients with HIV receiving care in India. Of 1667 persons surveyed, 609 (36%) had heard of ART and 19% of these persons reported that ART could cure HIV. Twenty-four percent reported that they were currently taking ART, with 18% of these patients not actually on ART according to their provider. Major barriers to taking ART were cost (33%), lack of knowledge of ART (41%), and deferral by physician (30%). More than half of all public and private patients had not heard of CD4 (57%) or viral load testing (80%), and even fewer had received these tests (32% and 11%, respectively). Private clinic attendees were almost 4 times more likely to be on ART (35% versus 9%, p < 0.0001), more likely to be male, have a higher education, be partnered, have a higher income, and have had a CD4 or viral load (p < 0.0001). Overall, low levels of ART knowledge and access were observed among HIV infected patients, with access to ART being particularly low among patients attending public clinics. In order to make widespread dissemination of ART effective in India, further educational and programmatic efforts are likely needed to optimize access, treatment awareness, and compliance among patients with HIV.
authors.affiliation: Department of Internal Medicine, National Naval Medical Center, Bethesda, Maryland, USA.
authors.forename: Suneil R
authors.initials: SR
authors.lastname: Ramchandani
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Dattatray G
authors.initials: DG
authors.lastname: Saple
authors.forename: Satish B
authors.initials: SB
authors.lastname: Vaidya
authors.forename: Ved P
authors.initials: VP
authors.lastname: Pandey
authors.forename: Ravi
authors.initials: R
authors.lastname: Vadrevu
authors.forename: Sikhamani
authors.initials: S
authors.lastname: Rajasekaran
authors.forename: Vandana
authors.initials: V
authors.lastname: Bhatia
authors.forename: Abhay
authors.initials: A
authors.lastname: Chowdhary
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000375:Aging; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010349:Patient Compliance / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D019380:Anti-HIV Agents