Clinical Infectious Diseases 2007;44:1235-1244 available at
http://www.journals.uchicago.edu/CID/journal/issues/v44n9/41525/41525.html

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

Bijal Shah, Louise Walshe, Dattary G. Saple, Shruti H. Mehta, Jeetender P.
Ramnani, R. D. Kharkar, Robert C. Bollinger, and Amita Gupta

Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North
Carolina; School of Medicine and Bloomberg School of Public Health, Johns
Hopkins University, Baltimore, Maryland; and Human 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.