Saha R, Saha I, Sarkar AP, Das DK, Misra R, Bhattacharya K, Roy RN, Bhattacharya A
Correpondence: Dr Rajib Saha, dr.rajsaha@gmail.com
ABSTRACT
INTRODUCTION The introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) has led to the reduction of mortality and the improvement of the quality of life of people living with HIV/AIDS (PLWHA). The present study was conducted to determine the pattern of adherence to HAART among PLWHA, and to assess the factor(s) affecting nonadherence, if any.
METHODS This study was a hospital-based analytical, cross-sectional epidemiological study conducted between July and October 2011. A total of 370 adult HIV-positive patients registered in the Antiretroviral Therapy Centre of Burdwan Medical College and Hospital, West Bengal, India, were included. Nonadherence was defined as missing at least a single dose of medicine within the last four days. Data was analysed using the Statistical Package for the Social Sciences version 19.0 (IBM Corp, Armonk, NY, USA).
RESULTS A total of 87.6% of patients were found to be adherent to HAART. Principal causes of nonadherence were forgetting to take medicine (70.2%), being away from home (65.2%), and busyness with other things (64.7%). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with a positive family history of HIV/AIDS (odds ratio [OR] 16; 95% confidence interval [CI] 2.2–114.3; p = 0.01), occurrence of side effects with HAART (OR 9.81; 95% CI 1.9–51.7; p = 0.01) and employment (OR 5.93; 95% CI 1.5–23.2; p = 0.01).
CONCLUSION Although overall adherence was high, the factors that affect nonadherence can be addressed with proper counselling and motivation of patients and their family members. Adherence to HAART could delay the progression of this lethal disease and minimise the risk of developing drug resistance.
Keywords: adherence to HAART, ART Centre, nonadherence to HAART, PLWHA
Singapore Med J 2014; 55(2): 92-98; http://dx.doi.org/10.11622/smedj.2014021
REFERENCES
1. UNAIDS. UNAIDS report on the global AIDS epidemic 2010 [online]. Available at: http://www.unaids.org/globalreport/global_report.htm. Accessed April 24, 2013. | ||||
2. Government of India. HIV Sentinel Surveillance and HIV estimation in India 2007, A Technical Brief. New Delhi: NACO, Ministry Of Health and Family Welfare, 2008. | ||||
3. West Bengal State AIDS Prevention and Control Society. Annual report 2009-10 [online]. Available at: www.wbhealth.gov.in/wbsapcs/report/Annual%20Report09-10Final.pdf. Last accessed April 10, 2012. | ||||
4. Mannheimer SB, Matts J, Telzak E, et al. Quality of life in HIV-infected individuals receiving antiretroviral therapy is related to adherence. AIDS Care 2005; 17:10-22. http://dx.doi.org/10.1080/09540120412331305098 | ||||
5. Tadios Y, Davey G. Antiretroviral treatment adherence and its correlates among people living with HIV/AIDS on highly active antiretroviral therapy in Addis Ababa, Ethiopia. Ethiop Med J 2006; 44:237-44. | ||||
6. Blower S, Ma L, Farmer P, Koenig S. Predicting the impact of antiretroviral in resource-poor settings: prevention of HIV infection whilst controlling drug resistance. Curr Drug Targets Infect Disord 2003; 3:345-53. http://dx.doi.org/10.2174/1568005033480999 | ||||
7. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000; 133:21-30. http://dx.doi.org/10.7326/0003-4819-133-1-200007040-00004 | ||||
8. Nischal KC, Khopkar U, Saple DG. Improving adherence to antiretroviral therapy. Indian J Dermatol Venereol Leprol 2005; 71:316-20. http://dx.doi.org/10.4103/0378-6323.16780 | ||||
9. Carter M. Adherence-information series for HIV-positive people. 3rd ed. London: NAM, 2005. | ||||
10. Hogg RS, Heath K, Bangsberg D, et al. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after one year of follow-up. AIDS 2002; 16:1051-8. http://dx.doi.org/10.1097/00002030-200205030-00012 | ||||
11. Adam BD, Maticka TE, Cohen JJ. Adherence practices among people living with HIV. AIDS Care 2003; 15:263-74. http://dx.doi.org/10.1080/0954012031000068407 | ||||
12. Malcolm SE, Ng JJ, Rosen RK, Stone VE. An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care 2003; 15:251- 61. http://dx.doi.org/10.1080/0954012031000068399 | ||||
13. World Health Organization. Adherence to HIV treatment, Geneva; 2003. (Department of HIV/AIDS unpublished internal technical brief). | ||||
14. Lameshow S, Lwanga SK. Sample size determination in health studies, a practical manual. Geneva: WHO, 1991. | ||||
15. Chesney MA, Ickovics JR, Chamben DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV CLINICAL trial: The AACTG adherence instruments. Patient Care Committee and Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trial Group (AACTG). AIDS Care 2000; 12:255-66. http://dx.doi.org/10.1080/09540120050042891 | ||||
16. Maggiolo F, Ravasio L, Ripamonti D, et al. Similar adherence rates favor different virologic outcomes for patients treated with nonnucleoside analogues or protease inhibitors. Clin Infect Dis 2005; 40:158-63. http://dx.doi.org/10.1086/426595 | ||||
17. Unge C, Södergård B, Marrone G, et al. Long-term adherence to antiretroviral treatment and program drop-out in a high-risk urban setting in sub-Saharan Africa: a prospective cohort study. PLoS One 2010; 5:e13613. http://dx.doi.org/10.1371/journal.pone.0013613 | ||||
18. Barfod TS, Sørensen HT, Nielsen H, Rodkjaer L, Obel N. "Simply forgot" is most frequently stated reason for missed doses of HAART irrespective of degree of adherence. HIV Med 2006; 7:285-90. http://dx.doi.org/10.1111/j.1468-1293.2006.00387.x | ||||
19. Sarna A, Pujari S, Sengar AK, et al. Adherence to antiretroviral therapy & its determinants among HIV patients in India. Indian J Med Res 2008; 127:28-36. | ||||
20. Shah B, Walshe L, Saple DG, et al. Adherence to antiretroviral therapy and virologic suppression among hiv-infected persons receiving care in private clinics in Mumbai, India. Clin Infect Dis 2007; 44:1235-44. http://dx.doi.org/10.1086/513429 | ||||
21. Ekstrand ML, Chandy S, Heylen E, Steward W, Singh G. Developing useful highly active antiretroviral therapy adherence measures for India: the Prerana study. J Acquir Immune Defic Syndr 2010; 53:415-6. http://dx.doi.org/10.1097/QAI.0b013e3181ba3e4e | ||||
22. Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA 2006; 296:679-90. http://dx.doi.org/10.1001/jama.296.6.679 | ||||
23. Bachani D, Rewari BB. Antiretroviral therapy: practice guidelines and National ART Programme. J Indian Med Assoc 2009; 107:310-4. | ||||
24. Sundar Lal, Adarsh, Pankaj. Textbook of Community Medicine. 3rd ed. New Delhi: CBS Publishers & Distributors Pvt Ltd, 2011: 17-20. | ||||
25. Wanchu A, Kaur R, Bamberry P, Singh S. Adherence to generic reverse transcriptase inhibitor-based antiretroviral medication at a tertiary centre in North India. AIDS Behav 2007; 11:99-102. http://dx.doi.org/10.1007/s10461-006-9101-y | ||||
26. Lanièce I, Ciss M, Desclaux A, et al. Adherence to HAART and its principal determinants in a cohort of Senegalese adults. AIDS 2003; 17(Suppl 3):S103-8. http://dx.doi.org/10.1097/00002030-200317003-00014 | ||||
27. Orwell C, Bangsberg DR, Badri M, Wood R. Adherence is not a barrier to successful antiretroviral therapy in South Africa. AIDS 2003; 17:1369-75. http://dx.doi.org/10.1097/00002030-200306130-00011 | ||||
28. Ivers L, Kendrick D, Doucette K. Efficacy of antiretroviral therapy programs in resource-poor settings: a meta-analysis of the published literature. Clin Infect Dis 2005; 41:217-24. http://dx.doi.org/10.1086/431199 | ||||
29. Safren S, Kumarasamy N, James R, et al. ART adherence, demographic variables and CD4 outcome among HIV-positive patients on antiretroviral therapy in Chennai, India. AIDS Care 2005; 17:853-62. http://dx.doi.org/10.1080/09540120500038439 | ||||
30. Kumaraswamy N, Safren SA, Raminani SR, et al. Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study. AIDS Patient Care STDS 2005; 19:526-37. http://dx.doi.org/10.1089/apc.2005.19.526 | ||||
31. Sarna A, Gupta I, Pujari S, et al. Examining adherence and sexual behaviour among patients on antiretroviral therapy in India. Horizons Final Report Washington, DC: Population Council; 2006. | ||||
32. Murri R, Ammassari A, De Luca LA, et al. Self-reported non adherence with antiretroviral drugs predicts persistent condition. HIV Clin Trials 2001; 2:323-9. http://dx.doi.org/10.1310/KDM0-RU5W-NVTW-N9MC | ||||
33. Frank I. Once-daily HAART: toward a new treatment paradigm. J Acquir Immune Defic Syndr 2002; 31(suppl 1):S10-15. http://dx.doi.org/10.1097/00126334-200209011-00003 | ||||
34. Fogarty L, Roter D, Larson S, et al. Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Educ Couns 2002; 46:93-108. http://dx.doi.org/10.1016/S0738-3991(01)00219-1 | ||||
35. Cauldbeck MB, O'Connor C, O'Connor MB, et al. Adherence to antiretroviral therapy among HIV patients in Bangalore, India. AIDS Res Ther 2009; 6:7 http://dx.doi.org/10.1186/1742-6405-6-7 | ||||
36. Paasche-Orlow MK, Cheng DM, Palepu A, et al. Health literacy, antiretroviral adherence, and HIV-RNA suppression: a longitudinal perspective. J Gen Intern Med 2006; 21:835-40. http://dx.doi.org/10.1111/j.1525-1497.2006.00527.x | ||||
37. Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA 2006; 296:679-90. http://dx.doi.org/10.1001/jama.296.6.679 | ||||
38. Igwegbe AO, Ugboaja JO, Nwajiaku LA. Prevalence and determinants of non-adherence to antiretroviral therapy among HIV positive pregnant women in Nnewi, Nigeria. Int J Med Med Sci 2010; 2:238-45. | ||||
39. Amberbir A, Woldemichael K, Getachew S, Girma B, Deribe K. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia. BMC Public Health 2008; 8:265. http://dx.doi.org/10.1186/1471-2458-8-265 | ||||
40. Lee LS, Soon GH, Teo YY. Inter-ethnic differences in efavirenz CNS toxicity – role of cytochrome P450 2B6 polymorphisms. BMC Infect Dis 2012; 12(suppl 1): O17. http://dx.doi.org/10.1186/1471-2334-12-S1-O17 | ||||
41. Gatanaga H, Hayashida T, Tsuchiya K, et al. Successful efavirenz dose reduction in HIV type 1-infected individuals with cytochrome P450 2B6 *6 and *26. Clin Infect Dis 2007; 45:1230-1237. http://dx.doi.org/10.1086/522175 |