title: Reasons for and correlates of antiretroviral treatment interruptions in a cohort of patients from public and private clinics in southern India.
abstract: Understanding the prevalence and correlates of treatment interruptions (TIs) in resource-limited settings is important for improving adherence. HIV-infected adults on highly active antiretroviral therapy (HAART) in Bangalore, India, were enrolled into a prospective cohort study assessing HAART adherence. Participants underwent a structured interview assessing adherence, including occurrence of TI > 48 hours since HAART initiation, length of TI, and self-reported reasons for TI. Serum HIV viral load (VL) and CD4 was measured at 6-month intervals. Baseline data are presented in this article. For the 552 participants mean age was 37.8, 32% were female, 70% were married, 45% earned < $2/day. Eighty-four percent were on nevirapine-based antiretroviral therapy; median duration on HAART was 18 months (range: 1-175) and median CD4 count was 318 cells/µl (IQR: 195-460) at time of study enrollment. Twenty percent (n=110) reported at least one TI; of these, 33% (n=36) reported more than one TI. Median length of most recent TI was 10 days (range: 2-1095). TI was associated with a higher probability of having VL > 400 copies/ml (43% versus 12%; p<0.001). After controlling for time on HAART, TI was more likely among those who were unmarried (OR: 1.9; CI: 1.2-3.1), those treated in a private clinic setting (OR: 2.7; CI: 1.6-4.6 compared with public, and OR: 4.1; CI: 1.9-9.0 compared with public-private setting), and those on efavirenz-based therapy (OR: 2.0; CI: 1.1-3.6). The most common self-reported reason for TI was "side effects" (n=28; 25%), followed by cost of therapy (n=24; 22%). We discuss implications for both individual and structural level interventions to reduce TIs.
authors: Center for AIDS Prevention Studies, University of California, San Francisco, USA. snigdhav@gmail.com
authors: Snigdha
authors: S
authors: Vallabhaneni
authors: Sara
authors: S
authors: Chandy
authors: Elsa
authors: E
authors: Heylen
authors: Maria
authors: M
authors: Ekstrand
mesh_terms: D000328:Adult; D000480:Alkynes; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003521:Cyclopropanes; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015497:HIV-1; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D019829:Nevirapine / Q000008:administration & dosage*; D017149:Private Sector; D011446:Prospective Studies; D017150:Public Sector; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D019829:Nevirapine; C098320:efavirenz