Joshi Beena, Chauhan Sanjay, Pasi Achhelal, Kulkarni Ragini, Sunil Nithya, Bachani Damodar, Mankeshwar Ranjit
National Institute for Research in Reproductive Health (ICMR), Mumbai, India.
Indian J Med Res. 2014 Jul;140(1):84-95.
BACKGROUND & OBJECTIVES: 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.
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.
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).
INTERPRETATION & 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.
印度国家抗逆转录病毒治疗（ART）项目于2004年启动。自那时起，尚无关于公共机构中接受一线抗逆转录病毒治疗的艾滋病毒感染者（PLHIV）依从性欠佳情况的全国代表性估计数据。因此，在印度15个邦开展了一项多中心研究，以评估PLHIV中依从性欠佳的程度及其决定因素。
采用前瞻性观察性研究设计，在印度30个抗逆转录病毒治疗中心招募了3285名PLHIV，并对其进行了为期6个月的随访。使用药丸计数法和自我报告回忆法评估依从性，并根据他们对各种问题的回答探讨依从性欠佳的决定因素。
24.5%的PLHIV存在依从性欠佳情况。依从性欠佳的决定因素包括文盲（比值比[OR]——1.341，可信区间[CI]——1.080至1.665）、接受抗逆转录病毒治疗少于6个月（OR——1.540，CI——1.280至1.853）、男性（女性的OR——0.807，CI——0.662至0.982）、部落居民（OR——2.246，CI——1.134至4.447）、采用依非韦伦（EFA）治疗方案（OR——1.479，CI——1.190至1.837）、存在焦虑情绪（OR——1.375，CI——1.117至1.692）、未向家人透露艾滋病毒感染状况（OR——1.549，CI——1.176至2.039）、缺乏治疗动力（OR——1.389，CI——1.093至1.756）、被朋友忽视（OR——1.368，CI——1.069至1.751）、频繁更换居住地（OR——3.373，CI——2.659至4.278）、交通费用（OR——1.364，CI——1.138至1.649）、未在抗逆转录病毒治疗中心与PLHIV志愿者/社区护理协调员会面（OR——1.639，CI——1.330至2.019）。
为加强对易出现依从性欠佳情况的PLHIV的识别，需要根据研究结果更新国家抗逆转录病毒治疗指南中用于识别依从性障碍的现有清单。需要提高综合依从性支持服务的质量，并加强对依从性测量的严格监测。
