title: Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India.
abstract: 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 > or = 95% adherence to ART. Adherence was positively associated with age > or = 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 > or = 3 ART drugs (aOR, 5.52), first ART regimen (aOR, 3.28), adherence to therapy > or = 95% (aOR, 5.70), female sex (aOR, 3.19), and a physical component score > or = 50 (aOR, 1.07).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: Bijal
authors.initials: B
authors.lastname: Shah
authors.forename: Louise
authors.initials: L
authors.lastname: Walshe
authors.forename: Dattary G
authors.initials: DG
authors.lastname: Saple
authors.forename: Shruti H
authors.initials: SH
authors.lastname: Mehta
authors.forename: Jeetender P
authors.initials: JP
authors.lastname: Ramnani
authors.forename: R D
authors.initials: RD
authors.lastname: Kharkar
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bollinger
authors.forename: Amita
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006269:Health Facilities, Proprietary; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D014505:Urban Population; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents