title: Targets for intervention to improve virological outcomes for patients receiving free antiretroviral therapy in Tamil Nadu, India.
abstract: Operational research to identify factors predicting poor clinical outcomes is critical to maximize patient care and prolong first-line regimens for those receiving free antiretroviral therapy (ART) in India. We sought to identify social or clinical factors amenable to intervention that predict virological outcomes after 12 months of ART. We examined a retrospective cohort of consecutive adults initiating free nonnucleoside reverse transcriptase inhibitor-based regimens. Individuals remaining in care 12 months post-ART initiation were tested for HIV viral load and surveyed to identify barriers and facilitators to adherence, and to determine clinic travel times and associated costs. Uni- and multivariate logistic regression identified factors predicting HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults initiating ART, 10% of patients died, 8% transferred out, 5% were lost to follow-up, and 174/230 (76%) completed 12 months of ART, the questionnaire, and viral load testing. HIV viral load was <200 copies/mL in 140/174 (80%) patients. In multivariate models, being busy with work or caring for others (OR 2.9, p < 0.01), having clinic transport times ≥ 3 hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted viral load >200 copies/mL after 12 months of ART. Clinical outcomes following ART are related to programmatic factors such as prolonged travel time and individual factors such as being busy with family or using alcohol. Simple interventions that alter these factors should be evaluated to improve clinical outcomes for populations receiving free ART in similar settings.
authors.affiliation: a Infectious Diseases Unit , Alfred Hospital , Melbourne , VIC , Australia.
authors.forename: James H
authors.initials: JH
authors.lastname: McMahon
authors.forename: Anand
authors.initials: A
authors.lastname: Manoharan
authors.forename: Christine
authors.initials: C
authors.lastname: Wanke
authors.forename: Shoba
authors.initials: S
authors.lastname: Mammen
authors.forename: Hepsibah
authors.initials: H
authors.lastname: Jose
authors.forename: Thabeetha
authors.initials: T
authors.lastname: Malini
authors.forename: Tony
authors.initials: T
authors.lastname: Kadavanu
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
authors.forename: Julian H
authors.initials: JH
authors.lastname: Elliott
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Lewin
authors.forename: Dilip
authors.initials: D
authors.lastname: Mathai
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D015331:Cohort Studies; D017281:Cost of Illness; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D012367:RNA, Viral / Q000302:isolation & purification; D012189:Retrospective Studies; D014186:Transportation / Q000191:economics / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral