Factors Influencing Adherence to Anti-retroviral Therapy in HIV Patients Registered at ART Center Jhansi, Uttar Pradesh


  • Sudha Sharma MLB Medical College, Jhansi, Uttar Pradesh, India
  • Mehar Bano MLB Medical College, Jhansi, Uttar Pradesh, India
  • Anil Kumar Malhotra MLB Medical College, Jhansi, Uttar Pradesh, India




Adherence, ART, PLHIV, ART Center, ACTG Questionnaire, Uttar Pradesh


Context: After introducing ‘Treat all policy’ in the country and free ART (Anti-retroviral therapy) for all patients the biggest challenge is to optimize adherence to therapy and ensure viral suppression. The present study is aimed to determine the adherence pattern of HIV positive patients at ART center, Jhansi in Uttar Pradesh and to determine the factors influencing adherence.

Methods and Material: This cross-sectional study was conducted in an ART Centre of a teaching hospital. In this study 357 patients were interviewed using a modified version of ACTG questionnaire and adherence was calculated by pill count and recall method. Chi square test and logistic regression was done using SPSS.

Results: Nearly 72% patients had optimum adherence. On univariate analysis the factors found significant were sex of the patient, the education, the socioeconomic status, financial constraints, family support, WHO stage at diagnosis, alcohol addiction and tobacco addiction. On logistic regression four factors namely having less than college education, WHO stage at diagnosis, alcohol intake and lack of family support were found to predictors of non-adherence.

Conclusions: Family support, treatment of alcohol addiction will improve adherence in HIV positive patients.


National AIDS Control Organization & ICMR-National Insti-tute of Medical Statistics (2020). India HIV Estimates 2019: Report. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. pages-xxii-xxiii. [https://tnsacs.in/cmsimage//Reports/01102020121007.pdf]

Government of India, Annual Report 2019-20, Ministry of Health and Family Welfare Nirman Bhawan, New Delhi ,page-425 [https://main.mohfw.gov.in/sites/default/files/Annual%20Report%202019-2020%20English.pdf]

National AIDS Control Organization, National Technical Guidelines on Anti-Retroviral Treatment.2018, New Delhi: NACO, Ministry of Health and Family Welfare, Government of India.page 45 [http://naco.gov.in/sites/default/files/NACO%20-%20National%20Technical%20Guidelines%20on%20ART_October%202018%20%281%29.pdf]

Nischal KC, Khopkar U, Saple DG. Improving adherence to antiretroviral therapy. Indian Journal of Dermatol Venereol Leprol. 2005;71(5):316-20. Doi: https://doi.org/10.4103/0378-6323.16780 PMid:16394454

Garcia de Olalla P, Knobel H, Carmona A, Guelar A, Lopez-Colomes JL, Cayla JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. J Acquir Immune Defic Syndr. 2002;30:105-10. Doi: https://doi.org/10.1097/00042560-200205010-00014 PMid:12048370

Fraser S. Concordance, compliance, preference or adherence. Patient Prefer Adherence. 2010;4:95-96. Doi: https://doi.org/10.2147/PPA.S17167 PMid:22090796 PMCid:PMC3217341

Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollen-dorf DA, et al. Medication compliance and persistence: ter-minology and definitions. Value Health. 2008;11:44-47. Doi: https://doi.org/10.1111/j.1524-4733.2007.00213.x PMid:18237359

Vrijens B, De Geest S, Hughes DA, Przemyslaw K, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defin-ing adherence to medications. Br J Clin Pharmacol. 2012;73:691-705. Doi: https://doi.org/10.1111/j.1365-2125.2012.04167.x PMid:22486599 PMCid:PMC3403197

Mhaskar R, Alandikar V, Emmanuel P, Djulbegovic B, Patel S, Patel A et al. Adherence to antiretroviral therapy in India: a systematic review and meta-analysis. Indian J Community Med. 2013;38(2):74-82. Doi: https://doi.org/10.4103/0970-0218.112435 PMid:23878418 PMCid:PMC3714945

Reynolds NR, Sun J, Nagaraja HN, Gifford AL, Wu AW, Chesney MA. Optimizing measurement of self-reported ad-herence with the ACTG Adherence Questionnaire: a cross-protocol analysis. J Acquir Immune Defic Syndr. 2007;46(4):402-9. Doi: https://doi.org/10.1097/QAI.0b013e318158a44f PMid:18077832

Debnath DJ. Kakkar R. Modified BG Prasad Socio-economic Classification, Updated - 2020. Indian J Comm Health.2020;32(1):124-125. Doi: https://doi.org/10.47203/IJCH.2020.v32i01.024

Kroenke, K. & Spitzer, R.L. (2002). The PHQ-9: A new de-pression and diagnostic severity measure. Psychiatric An-nals, 32, 509-521. Doi: https://doi.org/10.3928/0048-5713-20020901-06

K Park. Park's Textbook of Preventive and Social Medicine, 25th ed. Jabalpur: Bhanot Publishers; 2019. 377-78.

Shukla M, Agarwal M, Singh JV, Tripathi AK, Srivastava AK, Singh VK, et al. Nonadherence to antiretroviral therapy among people living with HIV/AIDS attending two tertiary care hospitals in district of Northern India. Indian J Com-munity Med. 2016;41:55-61. Doi: https://doi.org/10.4103/0970-0218.170970 PMid:26917875 PMCid:PMC4746956

Hasabi IS, Shivashankarappa AB, Kachapur C, Kaulgud RS. A Study of Compliance to Antiretroviral Therapy among HIV Infected Patients at a Tertiary Care Hospital in North Karna-taka. J Clin Diagn Res. 2016;10(5):27-31. Doi: https://doi.org/10.7860/JCDR/2016/17948.7792 PMid:27437267 PMCid:PMC4948443

Alvi Y, Khalique N, Ahmad A, Khan HS, Faizi N. World Health Organization Dimensions of Adherence to Antiretroviral Therapy: A Study at Antiretroviral Therapy Centre, Aligarh. Indian J Community Med. 2019;44(2):118-124.

Joshi B, Chauhan S, Pasi A, Kulkarni R, Sunil N, Bachani D. Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India. Indian J Med Res. 2014;140:84-95.

Raju BN, Anusuya GS, HariLaxmi V, Johnson C, Radhakrish-nan E, Ravi R et al. Factors affecting adherence to antiretro-viral therapy in Andhra Pradesh, India. Int J Community Med Public Health. 2019;6(3):1010-1014. Doi: https://doi.org/10.18203/2394-6040.ijcmph20190430

Saha R, Saha I, Sarkar AP, Das DK, Misra R, Bhattacharya K, et al. Adherence to highly active antiretroviral therapy in a tertiary care hospital in West Bengal, India. Singapore Med J. 2014;55:92-9. Doi: https://doi.org/10.11622/smedj.2014021 PMid:24570318 PMCid:PMC4291929

Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, Dam J. Adher-ence to antiretroviral therapy & its determinants amongst HIV patients in India. Indian J Med Res. 2008;127(1):28-36.

Kleinman NJ, Manhart LE, Mohanraj R, Kumar S, Jeyaseelan L, Rao D, Simoni JM. Antiretroviral therapy adherence meas-urement in non-clinical settings in South India. AIDS Care. 2015;27(2):248-54. Doi: https://doi.org/10.1080/09540121.2014.946382 PMid:25119585 PMCid:PMC5076017

Giri PA, Deshpande JD, Phalke DB. Prevalence of Pulmonary Tuberculosis Among HIV Positive Patients Attending An-tiretroviral Therapy Clinic. N Am J Med Sci. 2013;5(6):367-370. Doi: https://doi.org/10.4103/1947-2714.114169 PMid:23923111 PMCid:PMC3731868

Vedhanayagam M, Rajagopalam R, Rajendra BB, Sendogan S, Sendogan SK. Factors associated with anti-retroviral thera-py adherence among people living with HIV visiting IRT Pe-rundurai medical college hospital link ART centre, Perun-durai, Tamilnadu, India. International Journal of Advances in Medicine, 2016;3(4):982-8. Available from: https://dx.doi.org/10.18203/2349-3933.ijam20163735 [accessed on 30/11/2022] Doi: https://doi.org/10.18203/2349-3933.ijam20163735




How to Cite

Sharma S, Bano M, Malhotra AK. Factors Influencing Adherence to Anti-retroviral Therapy in HIV Patients Registered at ART Center Jhansi, Uttar Pradesh. Natl J Community Med [Internet]. 2022 Dec. 31 [cited 2023 Feb. 4];13(12):851-7. Available from: https://njcmindia.com/index.php/file/article/view/2537



Original Research Articles