Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings
Identifieur interne : 001503 ( Pmc/Corpus ); précédent : 001502; suivant : 001504Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings
Auteurs : Kartik K. Venkatesh ; A. K. Srikrishnan ; Kenneth H. Mayer ; N. Kumarasamy ; Sudha Raminani ; E. Thamburaj ; Lakshmi Prasad ; Elizabeth W. Triche ; Suniti Solomon ; Steven A. SafrenSource :
- AIDS Patient Care and STDs [ 1087-2914 ] ; 2010.
Abstract
In light of the increasing availability of generic highly active antiretroviral therapy (HAART) in India, further data are needed to examine variables associated with HAART nonadherence among HIV-infected Indians in clinical care. We conducted a cross-sectional analysis of 198 HIV-infected South Indian men and women between January and April 2008 receiving first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. Nonadherence was defined as taking less than 95% of HAART doses in the last 1 month, and was examined using multivariable logistic regression models. Half of the participants reported less than 95% adherence to HAART, and 50% had been on HAART for more than 24 months. The median CD4 cell count was 435 cells per microliter. An increased odds of nonadherence was found for participants with current CD4 cell counts greater than 500 cells per microliter (adjusted odds ratio [AOR]: 2.22 [95% confidence interval {CI}: 1.04–4.75];
Url:
DOI: 10.1089/apc.2010.0153
PubMed: 21091232
PubMed Central: 3011993
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PMC:3011993Le document en format XML
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<series><title level="j">AIDS Patient Care and STDs</title>
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<front><div type="abstract" xml:lang="en"><title>Abstract</title>
<p>In light of the increasing availability of generic highly active antiretroviral therapy (HAART) in India, further data are needed to examine variables associated with HAART nonadherence among HIV-infected Indians in clinical care. We conducted a cross-sectional analysis of 198 HIV-infected South Indian men and women between January and April 2008 receiving first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. Nonadherence was defined as taking less than 95% of HAART doses in the last 1 month, and was examined using multivariable logistic regression models. Half of the participants reported less than 95% adherence to HAART, and 50% had been on HAART for more than 24 months. The median CD4 cell count was 435 cells per microliter. An increased odds of nonadherence was found for participants with current CD4 cell counts greater than 500 cells per microliter (adjusted odds ratio [AOR]: 2.22 [95% confidence interval {CI}: 1.04–4.75]; <italic>p</italic>
= 0.038), who were on HAART for more than 24 months (AOR: 3.07 [95% CI: 1.35–7.01]; <italic>p</italic>
= 0.007), who reported alcohol use (AOR: 5.68 [95%CI: 2.10-15.32]; <italic>p</italic>
= 0.001), who had low general health perceptions (AOR: 3.58 [95%CI: 1.20-10.66]; <italic>p</italic>
= 0.021), and who had high distress (AOR: 3.32 [95%CI: 1.19-9.26]; <italic>p</italic>
= 0.022). This study documents several modifiable risk factors for nonadherence in a clinic population of HIV-infected Indians with substantial HAART experience. Further targeted culturally specific interventions are needed that address barriers to optimal adherence.</p>
</div>
</front>
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<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">AIDS Patient Care STDS</journal-id>
<journal-id journal-id-type="publisher-id">apc</journal-id>
<journal-title-group><journal-title>AIDS Patient Care and STDs</journal-title>
</journal-title-group>
<issn pub-type="ppub">1087-2914</issn>
<issn pub-type="epub">1557-7449</issn>
<publisher><publisher-name>Mary Ann Liebert, Inc.</publisher-name>
<publisher-loc>140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">21091232</article-id>
<article-id pub-id-type="pmc">3011993</article-id>
<article-id pub-id-type="publisher-id">10.1089/apc.2010.0153</article-id>
<article-id pub-id-type="doi">10.1089/apc.2010.0153</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Venkatesh</surname>
<given-names>Kartik K.</given-names>
</name>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Srikrishnan</surname>
<given-names>A.K.</given-names>
</name>
<degrees>B.A.</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Mayer</surname>
<given-names>Kenneth H.</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1,</sup>
</xref>
<xref ref-type="aff" rid="aff3"><sup>3,</sup>
</xref>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kumarasamy</surname>
<given-names>N.</given-names>
</name>
<degrees>MBBS, Ph.D.</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Raminani</surname>
<given-names>Sudha</given-names>
</name>
<degrees>M.A.</degrees>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thamburaj</surname>
<given-names>E.</given-names>
</name>
<degrees>M.S.W.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1,</sup>
</xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Prasad</surname>
<given-names>Lakshmi</given-names>
</name>
<degrees>M.A.</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Triche</surname>
<given-names>Elizabeth W.</given-names>
</name>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Solomon</surname>
<given-names>Suniti</given-names>
</name>
<degrees>M.D.</degrees>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Safren</surname>
<given-names>Steven A.</given-names>
</name>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="aff4"><sup>4,</sup>
</xref>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<aff id="aff1"><label><sup>1</sup>
</label>
Department of Community Health, Alpert Medical School,<institution>Brown University</institution>
, Providence, Rhode Island.</aff>
<aff id="aff2"><label><sup>2</sup>
</label>
<institution>YR Gaitonde Centre for AIDS Research and Education (YRG CARE)</institution>
, Chennai,<country>India</country>
.</aff>
<aff id="aff3"><label><sup>3</sup>
</label>
Division of Infectious Diseases, Department of Medicine, Alpert Medical School,<institution>Brown University/Miriam Hospital</institution>
, Providence, Rhode Island.</aff>
<aff id="aff4"><label><sup>4</sup>
</label>
<institution>Fenway Community Health</institution>
, Boston, Massachusetts.</aff>
<aff id="aff5"><label><sup>5</sup>
</label>
Department of Psychiatry,<institution>Harvard Medical School/Massachusetts General Hospital</institution>
, Boston, Massachusetts.</aff>
</contrib-group>
<author-notes><corresp>Address correspondence to: <italic>Kenneth H. Mayer, M.D., Infectious Diseases Division, Department of Medicine, Miriam Hospital, 164 Summit Avenue, Providence, RI 02906. E-mail:</italic>
<email xlink:href="mailto:Kenneth_Mayer@brown.edu">Kenneth_Mayer@brown.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>12</month>
<year>2010</year>
<pmc-comment>string-date: December 2010</pmc-comment>
</pub-date>
<volume>24</volume>
<issue>12</issue>
<fpage>795</fpage>
<lpage>803</lpage>
<permissions><copyright-statement>Copyright 2010, Mary Ann Liebert, Inc.</copyright-statement>
</permissions>
<self-uri xlink:type="simple" xlink:href="apc.2010.0153.pdf"></self-uri>
<abstract><title>Abstract</title>
<p>In light of the increasing availability of generic highly active antiretroviral therapy (HAART) in India, further data are needed to examine variables associated with HAART nonadherence among HIV-infected Indians in clinical care. We conducted a cross-sectional analysis of 198 HIV-infected South Indian men and women between January and April 2008 receiving first-line non-nucleoside reverse transcriptase inhibitor (NNRTI)-based HAART. Nonadherence was defined as taking less than 95% of HAART doses in the last 1 month, and was examined using multivariable logistic regression models. Half of the participants reported less than 95% adherence to HAART, and 50% had been on HAART for more than 24 months. The median CD4 cell count was 435 cells per microliter. An increased odds of nonadherence was found for participants with current CD4 cell counts greater than 500 cells per microliter (adjusted odds ratio [AOR]: 2.22 [95% confidence interval {CI}: 1.04–4.75]; <italic>p</italic>
= 0.038), who were on HAART for more than 24 months (AOR: 3.07 [95% CI: 1.35–7.01]; <italic>p</italic>
= 0.007), who reported alcohol use (AOR: 5.68 [95%CI: 2.10-15.32]; <italic>p</italic>
= 0.001), who had low general health perceptions (AOR: 3.58 [95%CI: 1.20-10.66]; <italic>p</italic>
= 0.021), and who had high distress (AOR: 3.32 [95%CI: 1.19-9.26]; <italic>p</italic>
= 0.022). This study documents several modifiable risk factors for nonadherence in a clinic population of HIV-infected Indians with substantial HAART experience. Further targeted culturally specific interventions are needed that address barriers to optimal adherence.</p>
</abstract>
<counts><table-count count="3"></table-count>
<ref-count count="50"></ref-count>
<page-count count="9"></page-count>
</counts>
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</front>
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