title: Factors influencing adherence to ART: new insights from a center providing free ART under the national program in Delhi, India.
abstract: BACKGROUND
  Adherence to therapy is central to the success of antiretroviral treatment (ART). With the availability of free ART under the national program in India, cost of ART is no longer the primary determinant of adherence. This study evaluated the adherence and factors influencing it among patients receiving free ART in a public health ART center in India.
  
  
  METHODS
  The adherence and its influences among 250 HIV-positive patients on first line ART for at least 3 months from the ART Center of Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India were analyzed. The adherence was assessed by patients' self report using the adult AIDS Clinical Trial Group (ACTG) questionnaire and counter checked with pharmacy records. The association of various parameters affecting adherence levels was analyzed by using SPSS package and Epiinfo software.
  
  
  RESULTS
  Of the 250 patients, 242 (96.8%) had optimum adherence (>95%) and 8 (3.2%) were "non-adherent." CD4 counts (P = 0.05), high level of belief among patients, patients' knowledge about importance of adherence (P = 0.04), and sound mental health were positively influencing adherence. The main barriers to adherence were poor mental health and negative psychological states in the patients (0.001). The presence of adverse reactions to ART also resulted in poorer adherence.
  
  
  CONCLUSIONS
  The modifiable factors most strongly associated with good adherence rates were higher current CD4 counts, patients' beliefs in ART, and positive mental health. These factors can be targeted by simple, practical interventions to improve and maintain high adherence levels.
authors.affiliation: Department of Medicine, Maulana Azad Medical College, New Delhi, India.
authors.forename: S
authors.initials: S
authors.lastname: Anuradha
authors.forename: Anant
authors.initials: A
authors.lastname: Joshi
authors.forename: Madhubala
authors.initials: M
authors.lastname: Negi
authors.forename: Neeraj
authors.initials: N
authors.lastname: Nischal
authors.forename: K
authors.initials: K
authors.lastname: Rajeshwari
authors.forename: Richa
authors.initials: R
authors.lastname: Dewan
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009313:National Health Programs; D012307:Risk Factors; D012959:Socioeconomic Factors
chemical_list: D044966:Anti-Retroviral Agents