Adherence to Antiretroviral Therapy and Its Effect on Survival of HIV-Infected Individuals in Jharkhand, India

Abstract

IntroductionResearch in India has extensively examined the factors associated with non-adherence to antiretroviral therapy (ART) with limited focus on examining the relationship between adherence to ART regimen and survival status of HIV infected patients. This study examines the effect of optimal adherence to ART on survival status of HIV infected patients attending ART centers in Jharkhand, India.Materials and MethodsData from a cohort of 239 HIV infected individuals who were initiated ART in 2007 were compiled from medical records retrospectively for 36 months. Socio-demographic characteristics, CD4 T cell count, presence of opportunistic infections at the time of ART initiation and ART regimen intake and survival status was collected periodically. Optimal adherence was assessed using pill count methods; patients who took <95% of the specified regimens were identified as non-adherent. Cox-proportional hazard model was used to determine the relative hazards of mortality.ResultsMore than three-fourths of the patients were male, on an average 34 year old and median CD4 T cell count was 118 cells/cmm at the time of ART registration. About 57% of the patients registered for ART were found to be adherent to ART. A total of 104 patients died in 358.5 patient-years of observation resulting in a mortality rate of 29 per 100 patient-years (95% confidence interval (CI): 23.9–35.2) and median survival time of 6.5 months (CI: 2.7–10.9). The mortality rate was higher among patients who were non-adherent to ART (64.5, CI: 50.5–82.4) than who were adherent (15.4, CI: 11.3–21.0). The risk of mortality was fourfold higher among individuals who were non-adherent to ART than who were adherent (Adjusted hazard ratio: 3.9, CI: 2.6–6.0).ConclusionAdherence to ART is associated with a higher chance of survival of HIV infected patients, ascertaining the need for interventions to improve the ART adherence and early initiation of ART.

Antiretroviral treatment adherence and associated factors among people living with HIV in developing country, Myanmar

“…The overall adherence level in this study was 76.24%, which was a bit disparity with previous studies 75% 15 and 85% 16 conducted in Yangon Region. In fact the level of adherence in this study was rather higher than other studies across the South East Asia Region where ART adherence varied widely from 57% to 75% [19][20][21] and the study undertaken in developed country like Latin America, reported the ART adherence as 55%. 22 This may be due to the differences in timing of the study, different measuring tools to assess the adherence level, different settings, and nature of availability of the drugs.…”

Determination of Predictors Associated With HIV/AIDS Patients on ART Using Accelerated Failure Time Model for Interval Censored Survival Data

“…Patients with CD4 cell <200 cells/mm 3 have 3.31 times more hazard to die than patient who had CD4 cell more than 200 cells/mm 3 . The mortality is inversely proportional to CD4 count, cumulative probability of AIDS and death increased substantially with decreasing CD4 cell count Ghate et al (2011;ATCC, 2009;May et al, 2007;Rai et al, 2013;Rajasekaran et al, 2009;Kee et al, 2009). It emphasizes the importance of creating awareness about early diagnosis so that the eligible patients can be initiated on ART earlier.…”

“…There are several studies which describes the estimation of survival of HIV populations and underlying covariates effect on hazard of death among HIV patients on ART by using Cox proportional hazard model for right censored data in India and resource limited setting countries (Ghate et al, 2011;Rai et al, 2013;Kee et al, 2009;Jerene et al, 2006). However, no one has tried to identify the significant predictor associated with the survival of HIV/AIDS patients undergoing ART using parametric AFT Model under interval censored set up.…”

Antiretroviral therapy adherence measurement in non-clinical settings in South India

“…In India, adherence has been variably associated with socio-demographic characteristics (Cauldbeck et al, 2009; Rai et al, 2013; Safren et al, 2005; Sarna et al, 2008), but more consistently with psychosocial factors. Social support has been associated with higher adherence (Nyamathi et al, 2012; Shah et al, 2007), and depression is linked with poorer adherence (Anuradha et al, 2013; Nyamathi et al, 2012; Sarna et al, 2008).…”