Correlates of and barriers to ART adherence among adherence-challenged people living with HIV in southern India

ABSTRACT

Suboptimal adherence to Antiretroviral Therapy (ART) regimens can lead to the development of drug resistance, virologic and clinical failure, and, on the community level, the spread of drug-resistant HIV. To design effective interventions, it is crucial to understand locally specific barriers to optimal adherence. Self-report data from a cross-sectional sample of 527 adherence-challenged people living with HIV (PLWH) in the South-Indian state of Karnataka showed that they took on average 68% of prescribed doses in the past month. Large majorities of participants encountered individual (95%), social/structural (88%), and clinic/regimen (80%) adherence barriers. Multivariate linear regression analyses of past month adherence showed that disclosure to all adults in the household was positively related to adherence, as was employing a larger number of adherence strategies, perceiving more benefits of ART, and having been on ART for longer. Fears of stigmatization upon disclosure of HIV-status to friends and people at work were negatively related to adherence. These results suggest that some barriers, especially individual-level barriers like forgetfulness are very common and can be targeted with relatively simple individual-level strategies. Other barriers, related to fear of stigma and lack of disclosure may require family- or community-level interventions.

KEYWORDS:

• ART
• adherence
• HIV
• India

Acknowledgments

We wish to thank the staff and participants from the Chetana project. We also thank Jennifer Evans for her help with analyses in the early stages of the paper. This work was supported was provided by the NIH/NIMH under grant R01 MH095659 (PI M. Ekstrand).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported was provided by the NIH/NIMH [National Institute of Mental Health] under grant R01 MH095659 (PI M. Ekstrand).