A study on determinants of adherence to highly active anti-retroviral therapy in a tertiary care hospital

Sandeep B., Suraj B.


Background: Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) is a major global health problem. A major concern with scaling up of antiretroviral treatment in resource limited settings is the emergence of drug resistant viral strains due to sub-optimal adherence and the transmission of these resistant viral strains in the population. Adherence is the second largest predictor of progression to AIDS and death after CD4 count. Hence the aim of the present study was to evaluate adherence to HAART and its determinants among HIV/AIDS patients on first line HAART.

Methods: This study was cross-sectional, observational in nature carried out among two hundred and seventy (270) HIV/AIDS patients on HAART during December 2013 to November 2014 at ART centre. Frequencies, Proportions and logistic regression analysis were applied and statistical analysis was done using (SPSS) 17.0 version.

Results: Among the study population, 52.6% of the patients were male, 81.5% of them were adherent to HAART in the last 7 days recall. Most common reasons for missing HAART regimen in this study were simply forgetting (70%). On Bivariate analysis, Adherence levels was less among Female (p <0.025) compared to male patients, Adherence levels were more among patients who were Employed (p <0.01) compared to unemployed, patients taking only HAART medications (p <0.000) when compared to patients taking more than or equal to four medications, those taking two to three medications (p <0.000) when compared to patients taking more than or equal to four medications, patients in WHO stage I (p <0.00) compared to patients in WHO stage III, patients in WHO stage II (p <0.032) compared to patients in stage III and lastly patients who were never admitted to hospital (p <0.008) due to HIV related illness in the previous year of HAART medication compared to those admitted more than once.

Conclusions: Several demographic and treatment related factors influence adherence to HAART. Hence, addressing these factors and providing adherence support services are main strategies to decrease non-adherence and its consequences.


Adherence, Drug resistance, HIV/AIDS, Mortality, Opportunistic infections, Suboptimal-adherence

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HIV Sentinel Surveillance 2012-13: A Technical brief. Available from URL: 2012.

Hogg RS, Heath K, Bangsberg D, Yip B, Press N, O'Shaughnessy MV et al. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. AIDS. 2002;16:1051-8.

Safren SA, Kumarasamy N, James R, Raminani R, Solomon S, Mayer KH. ART adherence, demographic variables and CD4 outcome among HIV positive patients on antiretroviral therapy in Chennai, India. AIDS Care. 2005;17:853-62.

Shah B, Walshe L, Saple DG, Mehta SH, Kharkar RD, Gupta A et al. Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India. Clinical Infectious Diseases. 2007;44:1235-44.

Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, Vandem J. Adhernce to antiretroviral therapy and its determinants amongst HIV patients in India. Indian J Med Res. 2008;127:28-36.

Heckman BD, Catz SL, Heckman TG, Miller JG, Kalichman SC. Adherence to antiretroviral therapy in rural persons living with HIV disease in the United States. AIDS Care. 2004;16:219-30.

Godin G, Cote J , Naccache H, Lambert D, Trottier S. Prediction of adherence to antiretroviral therapy: A one-year longitudinal study. AIDS Care. 2005;17:493-504.

Afolabi MO, Ijadunola KT, Fatusi AO, Olasode OA. Determinants of adherence to antiretroviral drugs among people living with HIV/AIDS in the Ife-Ijesa zone of Osun state, Nigeria. Afr J Prm Health Care Fam Med. 2009;1:6.

Souleymane D, Michel A, Kanga KC. Determinants of adherence to highly active antiretroviral therapy among HIV-1-infected patients in Cote d'Ivoire. AIDS. 2007;21:1799-803.

Tadios Y, Davey G. Antiretroviral treatment adherence and its correlates in Addis Ababa, Ethiopia. Ethiop Med J. 2006;44:237-44.

Sullivan PS, Campsmith ML, Nakamura GV, Begley EB, Schulden J, Nakashima AK. Patient and regimen characteristics associated with self-reported nonadherence to antiretroviral therapy. PLoS ONE. 2007;2.