Vol 9, Issue 6, 2016 Online - 2455-3891 Print - 0974-2441 DOES PROVIDING FREE ANTIRETROVIRAL THERAPY ENSURE OPTIMAL ADHERENCE AMONG PEOPLE LIVING WITH HUMAN IMMUNODEFICIENCY VIRUS/ACQUIRED IMMUNODEFICIENCY SYNDROME? SNEHA DEEPAK MALLYA*, VEENA G KAMATH, SUMA NAIR, ASHA KAMATH Department of Community Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India. Email: sneha.kamath@manipal.edu Received: 11 July 2016, Revised and Accepted: 15 July 2016 ABSTRACT Objective: The present study was carried out with the objective of determining the level of adherence and factors affecting it among patients receiving free antiretroviral therapy (ART). Methods: A cross-sectional study design was adopted and 320 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome positive patients receiving free ART from a district hospital in Udupi were interviewed using a semi-structured questionnaire. Adherence to ART >95% of the prescribed medication was used as the cutoff for deciding on the treatment adherence. Results: An encouragingly high 96.9% of the individuals were adherent to the medication over the past month. However, 41.8% of the participants reported to have ever missed doses of ART. On univariate analysis, having ever consumed alcohol, absence of side effects such as fatigue and tingling/ numbness, having a feeling of sadness and sleep disturbances, being on efavirenz-based regimen, non-disclosure HIV status, being unsure of continuing lifelong treatment were significantly associated with non-adherence (p<0.05). Conclusion: Although non-adherence was of concern among a small proportion of participants, a large number of them reported to have ever missed doses of ART. This finding suggests that adherence rate may be lower over longer periods of time. Hence, periodic assessments may address patient specific barriers and help to improve the adherence rate among this population. Keywords: Adherence, Adults, Antiretroviral therapy, Determinants. INTRODUCTION Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) continues to be a global public health concern, and world over, an estimated 2 million people became newly infected with HIV in 2014 [1]. India has the third-largest number of people living with HIV/ AIDS. The free antiretroviral therapy (ART) program of India under the National AIDS Control Program has been providing treatment support to people infected with HIV since 2004. One of the biggest challenges of this program is maintaining the adherence levels among patients on ART; as the provision of no cost ART does not ensure optimal adherence to therapy. Studies have traditionally used a threshold of 95% or more to distinguish between optimal and suboptimal adherence [2,3]. Although studies have shown that adherence to ART improves the quality of life among HIV-positive patients, the requisite lifelong treatment affects its compliance [4,5]. Continuous monitoring of levels and patterns of adherence in different settings and addressing the factors and circumstances that lead to suboptimal adherence are vital for the success of the ART program as well as for the prevention of HIV drug resistance. Although free ART has been available for a considerable period, studies determining adherence to ART and factors affecting it are essential to assess the success of the program. Considering the lack of data pertaining to this issue in the current population, this study was planned to address the same among patients receiving no cost ART under the program. METHODS Using a cross-sectional design, 320 patients living with HIV/AIDS were interviewed at the ART center, district hospital, Udupi, when they came for a routine monthly check up and collection of drugs during the year 2011. Patients above 18 years and on first-line ART for more than 3 months were included in the study. Seriously ill patients who were not able to respond to the questions were excluded. Considering a 60% prevalence of complete adherence to ART [6], relative precision of 10% and 20% non-response rate for a finite population, the sample size was calculated to be 320. Following informed consent, those consenting and willing to participate in the study were interviewed using a modified, pretested, and validated questionnaire [7]. Apart from socio-demographic information, responses related to disclosure of HIV status, alcohol, and drug abuse were collected. Adverse drug effects based on patient-reported symptoms were recorded. Adherence was measured based on self-reports of missed doses. Those not willing to participate in the study were considered as non-respondents. Anthropometric variables such as height and current weight as well as the weight during initiation of ART were noted from the records. Disease was staged as per the World Health Organization (WHO) criteria and the current cluster of differentiation 4 (CD4) levels besides that at the time of treatment initiation was documented. Risk factors for HIV and diagnosed opportunistic infections if any were accessed from the case records for both respondents and non- respondents. Socio-economic status was assessed using modified Kuppuswamy scale. Information pertaining to monthly, weekly, and daily adherence to ART was queried from the participants. Data concerning treatment interruption since initiation of ART was also obtained. Monthly and weekly adherence to antiretroviral agents was computed by dividing the number of pills consumed daily over the past 1 month and week by the number of pills prescribed during the particular period and presented as a percentage. Only self-reported data were used for calculating the adherence to ART. Adherence levels were further classified based on the number of missed doses. Individuals were considered to have >95% adherence level if they had missed <3 doses, 80-95% if they missed Research Article © 2016 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2016.v9i6.14019