title: Adherence to antiretroviral therapy in India: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.
  
  
  RESULTS
  There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (P = 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59-81%, I(2) = 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor.
  
  
  CONCLUSIONS
  Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.
authors.affiliation: Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Florida, USA ; Clinical and Translational Science Institute, University of South Florida, Florida, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Mhaskar
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Alandikar
authors.forename: Patricia
authors.initials: P
authors.lastname: Emmanuel
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
authors.forename: Sangita
authors.initials: S
authors.lastname: Patel
authors.forename: Atul
authors.initials: A
authors.lastname: Patel
authors.forename: Eknath
authors.initials: E
authors.lastname: Naik
authors.forename: Shyam
authors.initials: S
authors.lastname: Mohapatra
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
keywords: Anti-retroviral therapy; India; systematic review; treatment compliance