title: Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India.
abstract: OBJECTIVE
  National Anti-retroviral treatment (ART) programme in India was launched in 2004. Since then, there has been no published country representative estimate of suboptimal adherence among people living with HIV (PLHIV) on first line ART in public settings. Hence a multicentric study was undertaken in 15 States of India to assess the level of suboptimal adherence and its determinants among PLHIV.
  
  
  METHODS
  Using a prospective observational study design, 3285 PLHIV were enrolled and followed up to six months across 30 ART centres in India. Adherence was assessed using pill count and self-reported recall method and determinants of suboptimal adherence were explored based on the responses to various issues as perceived by them.
  
  
  RESULTS
  Suboptimal adherence was found in 24.5 per cent PLHIV. Determinants of suboptimal adherence were illiteracy (OR--1.341, CI--1.080-1.665), on ART for less than 6 months (OR--1.540, CI--1.280-1.853), male gender (OR for females--0.807, CI--0.662-0.982), tribals (OR--2.246, CI--1.134-4.447), on efavirenz (EFA) regimen (OR--1.479, CI--1.190-1.837), presence of anxiety (OR--1.375, CI--1.117-1.692), non-disclosure of HIV status to family (OR--1.549, CI--1.176-2.039), not motivated for treatment (OR--1.389, CI--1.093-1.756), neglect from friends (OR--1.368, CI--1.069-1.751), frequent change of residence (OR--3.373, CI--2.659-4.278), travel expenses (OR--1.364, CI--1.138-1.649), not meeting the PLHIV volunteer/community care coordinator at the ART center (OR--1.639, CI--1.330-2.019).
  
  
  CONCLUSIONS
  To enhance identification of PLHIV vulnerable to suboptimal adherence, the existing checklist to identify the barriers to adherence in the National ART Guidelines needs to be updated based on the study findings. Quality of comprehensive adherence support services needs to be improved coupled with vigilant monitoring of adherence measurement.
authors.affiliation: National Institute for Research in Reproductive Health (ICMR), Mumbai, India.
authors.forename: Beena
authors.initials: B
authors.lastname: Joshi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chauhan
authors.forename: Achhelal
authors.initials: A
authors.lastname: Pasi
authors.forename: Ragini
authors.initials: R
authors.lastname: Kulkarni
authors.forename: Nithya
authors.initials: N
authors.lastname: Sunil
authors.forename: Damodar
authors.initials: D
authors.lastname: Bachani
authors.forename: Ranjit
authors.initials: R
authors.lastname: Mankeshwar
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D009042:Motivation; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012737:Sex Factors
chemical_list: D044966:Anti-Retroviral Agents