This document summarizes a study on barriers and facilitators of adherence to antiretroviral therapy (ART) among people living with HIV/AIDS (PLHA) at a government hospital in India. The study included 204 PLHA who were on first-line ART for either less than 1 year or more than 1 year. Key facilitators of adherence included belief in medication, understanding the need for adherence, accepting HIV status, social support, and good relationships with healthcare providers. Barriers included distance to the hospital, monthly pill refilling, forgetfulness (for those on ART <1 year), and job/financial problems (for those on ART >1 year). The study provides insight into factors that help or hinder ART

1. Barriers and Facilitators of“Adherence”to
ART at the Government Hospital of
Thoracic Medicine
BACKGROUND
I-TECH is the International Training and Education Center for Health. I-TECH was established in 2002 by U.S. Health Resources and Services Administration (HRSA)
in collaboration with (CDC) Global AIDS Program.
For more information about I-TECH’s activities and the countries in which we work, visit www.go2itech.org.
1.Government Hospital of Thoracic Medicine, Tambaram, Chennai
2.International Training and Education Center for Health (I-TECH) India, Chennai 3.National Institute of Epidemiology, Chennai
4.Karnataka Health Promotion Trust
Total number of patients who participated
in this study (N=204)
102
<1 year on ART 49% (50)
> 1year on ART 51% (52)
Adherence
group
Non Adherence
group
<1 year on ART 49% (50)
> 1year on ART 51% (52)
102
Facilitators of Adherence in PLHA
on ART < 1 year and > 1 year (N=102)
Living in
Own House 52% (105)
Relatives House 8% (18)
Rented House 39% (80)
Orphanage/Old age 1% (1)
Regimen Adherent Non Adherent
D4T/3TC/NVP 25% (25) 37% (38)
D4T/3TC/EFV 13% (13) 12% (12)
AZT/3TC/NVP 56% (57) 42% (43)
AZT/3TC/EFV 7% (7) 9% (9)
Regimen Substitution Adherent Non Adherent
D4T to AZT 23% (7) 5% (2)
AZT to D4T 33% (10) 24% (9)
EFV to NVP 33% (10) 60% (22)
NVP to EFV 10% (3) 11% (4)
Sex
Male 74% (150)
Female 26% (53)
Transgender 1% (1)
Education
Illiterate 16% (33)
Primary 23% (46)
Secondary 46% (93)
Higher Secondary 06% (12)
Diploma & above 10% (20)
Marital Status
Single 10% (21)
Married 66% (134)
Separated 07% (14)
Widowed 17% (35)
Working Status
Yes 76% (155)
No 24% (49)
P <0.05
1,4 2 3 1 1
Authors: Pradeep J , Shoba D , Ezhil R , Valan A.S , Mahilmaran A ,
1 2 1
Krishnarajasekhar O.R , Manoharan G , Chandrasekhar C .
1. Hogg RS et al: Intermittent use of triple-combination therapy is predictive of
mortalityatbaselineandafter1yearof followup-AIDS2002,16:1051-8.
2. Adam BD et al: J. Adherence practices among people living with HIV. AIDS
care2005,15(2):263-274. Presenting Author : Dr Pradeep Johnson
E-mail : dr.pradeepjohnson@gmail.com
Adherence is the second strongest
predictor of progression to AIDS and
death,afterCD4count[1]
Non adherence risks the development
ofdrugresistanceandfailureoftherapy
leaving lesser options for further
therapy[2]
There is a need to explore the barriers
and facilitators of adherence to ART at
the Government hospital of Thoracic
Medicine(GHTM),Tambaram
To study the barriers and facilitators of
adherencetoARTatGHTM,Tambaram.
Study Design
- Cross sectional
Study Participants
- PLHA > 15 years of age and on first
line ART
Exclusion Criteria
- PLHA on Second line ART
Data Collection
- Using Semi structured questionnaire
Ethical issues
- Institutional review board (IRB)
approval obtained
OBJECTIVE
METHODOLOGY
Respondent Group:
Demographic Profile of
the Respondents: (N = 204)
Facilitators of Adherence
in PLHA on ART (N=102)
Barriers of Adherence in PLHA
on ART (N=102)
Barriers of Adherence in PLHA on
ART < 1 year and > 1 year (N=102)
Barriers of Adherence in PLHA on
ART < 1 year and > 1 year (N=102)
CONCLUSIONS
The most important facilitators of adherence to
ART for both the groups were
Belief in medicine and seeing positive results
Understanding the need for adherence
Accepting HIV status
Good financial back up
Good relationship with the health care provider
HIV status disclosure to society and gaining social
support
The facilitators of adherence in PLHA on ART
< 1 year were
Support of peers and work place colleagues
Usage of reminder tools (mobile phone/wrist
watch alerts, TV/Radio program time, reminders
family/friends)
The facilitator of adherence on ART for
> 1 year was
Good financial back up
The barriers of adherence in both the groups
were
Once in a month pill refilling
Distance
The barrier of adherence in PLHA on ART
< 1 year was
Forgetfulness to take medicines
The barriers of adherence on ART for
> 1 year were
Job related problems
Financial constraints