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1 May 2007

Volume 44, Number 9
Clinical Infectious Diseases 2007;44:1235–1244
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4409-0017$15.00
DOI: 10.1086/513429
HIV/AIDS MAJOR ARTICLE

Adherence to Antiretroviral Therapy and Virologic Suppression among HIV‐Infected Persons Receiving Care in Private Clinics in Mumbai, India

Bijal Shah,1

Louise Walshe,2

Dattary G. Saple,4

Shruti H. Mehta,3

Jeetender P. Ramnani,3

R. D. Kharkar,4

Robert C. Bollinger,2,3 and

Amita Gupta2

1Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina; 2School of Medicine and 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; and 4Human Healthcare and Research Foundation, Mumbai, India

Background.Adherence to antiretroviral therapy (ART) and correlates of adherence and virologic suppression among human immunodeficiency virus (HIV)–infected persons receiving ART in private, outpatient clinics in India is unknown.

Methods.Between December 2004 and April 2005, persons receiving ART at 3 private clinics in Mumbai, India, were interviewed regarding HIV care and adherence to ART. Physicians also completed a survey for each participant. Quantitative HIV‐1 RNA level was determined for 200 participants.

Results.Of 279 participants, 73% reported 95% adherence to ART. Adherence was positively associated with age 50 years (adjusted odds ratio [aOR], 3.90), presence of comorbid conditions (aOR, 1.92), medication self‐efficacy (aOR, 4.01), absence of pain in the past month (aOR, 2.14), and support from family and friends (aOR, 2.57). Lack of reminders from family members to take medication (aOR, 0.27) was negatively associated with adherence. Of 200 participants, 127 (63.5%) had virologic suppression (RNA level, <400 copies/mL). Independent correlates of suppression were a regimen containing 3 ART drugs (aOR, 5.52), first ART regimen (aOR, 3.28), adherence to therapy 95% (aOR, 5.70), female sex (aOR, 3.19), and a physical component score 50 (aOR, 1.07).

Conclusion.Self‐reported adherence to ART in a sample of patients attending Mumbai’s private clinics was relatively high. However, the fact that a detectable viral level was found in nearly 40% of patients suggests that second‐line ART regimens, as well as an emphasis on adherence and appropriate ART regimens in India, is needed.

Received 6 November 2006; accepted 20 January 2007; electronically published 22 March 2007.

Reprints or correspondence: Dr. Amita Gupta, Div. of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins School of Medicine, 600 N. Wolfe St., Phipps 540B, Baltimore, MD 21287 ().

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Online publication date: 1-Jul-2008.
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Edward Stenehjem, Judith C Shlay. (2008) Sex-specific differences in treatment outcomes for patients with HIV and AIDS. Expert Review of Pharmacoeconomics & Outcomes Research 8:1, 51-63
Online publication date: 1-Mar-2008.
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  • Presented in part: 16th International AIDS Conference, Toronto, Canada, August 2006 (abstract THPE0194).

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