Barriers to ART adherence & follow ups among patients attending ART centres in Maharashtra, India.
OBJECTIVE
Adherence to ART is a patient specific issue influenced by a variety of situations that a patient may encounter, especially in resource-limited settings. A study was conducted to understand factors and influencers of adherence to ART and their follow ups among patients attending ART centres in Maharashtra, India.


METHODS
Between January and March 2009, barriers to ART adherence among 32 patients at three selected ART centres functioning under national ART roll-out programme in Maharashtra, India, were studied using qualitative methods. Consenting patients were interviewed to assess barriers to ART adherence. Constant comparison method was used to identify grounded codes.


RESULTS
Patients reported multiple barriers to ART adherence and follow up as (i) Financial barriers where the contributing factors were unemployment, economic dependency, and debt, (ii) social norm of attending family rituals, and fulfilling social obligations emerged as socio-cultural barriers, (iii) patients' belief, attitude and behaviour towards medication and self-perceived stigma were the reasons for sub-optimal adherence, and (iv) long waiting period, doctor-patient relationship and less time devoted in counselling at the center contributed to missed visits.


CONCLUSIONS
Mainstreaming ART can facilitate access and address 'missed doses' due to travel and migration. A 'morning' and 'evening' ART centre/s hours may reduce work absenteeism and help in time management. Proactive 'adherence probing' and probing on internalized stigma might optimize adherence. Adherence probing to prevent transitioning to suboptimal adherence among patients stable on ART is recommended.
National AIDS Research Institute, Bhosari, Pune, India.
N
N
Joglekar
R
R
Paranjape
R
R
Jain
G
G
Rahane
R
R
Potdar
K S
KS
Reddy
S
S
Sahay
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003469:Culture; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India / Q000453:epidemiology; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D057545:Social Stigma; D012959:Socioeconomic Factors
D044966:Anti-Retroviral Agents