Factors affecting adherence to highly active anti retroviral therapy in HIV positive patients - Southern India

Introduction: According to the National AIDS control organization (NACO) guidelines, the percentage of adherence to the HAART regimen should be >95% in order to get the maximum therapeutic effect and to decrease viral resistance. That means that a patient can miss only a single tablet unexpectedly in the course of one month. The motive behind the present study was to analyse the factors which affect the patient's adherence to Highly Active Antiretroviral Therapy in HIV positive patients in a tertiary care hospital in Southern India. Methods: A prospective study was conducted after obtaining approval from the institutional ethical committee and after obtaining informed consent from patients in a tertiary care hospital in Southern India from July 2006 till November 2007. Relevant data from HIV positive patients on the HAART regimen for a minimum of 1 month was recorded. Children were excluded from the study. Chi Square test was applied for the statistical analysis of data. Results: We obtained data from 313 HIV +ve patients on HAART during the study period. The patients consisted of 226 males and 87 females. High adherence was observed in females 64 (73.6%) P<0.02, X² = 5.18 as compared to males and this was due to the greater family support offered to them P<0.008, X² = 6.9. 135 (59.7%) of males showed high adherence due to the presence of a greater degree of health consciousness in them P<0.008, X² = 6.9. The reasons for low adherence in 91 (40.3%) males were the social stigma associated with their visit to ART centres in 74 (81.3%), lack of family support in 6 (6.5%) and financial problems in 11 (12%). 23(26.4%) females had low adherence due to depression, the distance from the ART centers was the reason in 17(73.9%), lack of family support was the reason in 1(4.3%) and financial problems were the reason in 5 (21.7%). Financial problems as the causes for nonadherence have been overcome presently, since the medicines are being given free of cost since June 2007. Conclusions: In the present study, females showed a higher degree of adherence due to family support and in males, the reason for a high degree of adherence was health consciousness. Time should be spent by the staff on duty at the drug dispensing centres to explain the benefits of adherence and the results of non adherence to the drug regimen to the patients and their caretakers to improve patient compliance. Dispensing the drugs free of cost has improved patient compliance in a vast majority of patients.