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LETTER TO EDITOR
Year : 2014  |  Volume : 3  |  Issue : 4  |  Page : 284-285

Study assessing the rate of compliance and factors affecting it in patients receiving antiretroviral therapy


1 Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
2 Undergraduate Student, Government Medical College, Miraj, Maharashtra, India
3 Department of Obstetrics and Gynaecology, Government Medical College, Miraj, Maharashtra, India

Date of Web Publication16-Oct-2014

Correspondence Address:
Mangala Bhaskar Murthy
Flat No. 8, Mahalakshmi Complex, Pushparaj Chowk, Near Rohini Hotel, Sangli - 416 416, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.143077

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How to cite this article:
Murthy MB, Maitreyee S, Murthy BK. Study assessing the rate of compliance and factors affecting it in patients receiving antiretroviral therapy. Int J Health Allied Sci 2014;3:284-5

How to cite this URL:
Murthy MB, Maitreyee S, Murthy BK. Study assessing the rate of compliance and factors affecting it in patients receiving antiretroviral therapy. Int J Health Allied Sci [serial online] 2014 [cited 2019 Sep 21];3:284-5. Available from: http://www.ijhas.in/text.asp?2014/3/4/284/143077

Sir,

In patients receiving antiretroviral therapy (ART), near 100% [1] compliance is necessary to suppress viral replication effectively. Noncompliance, on the other hand, leads to reduced response to current therapy as well as future treatment and spread of resistant viruses in the community. This study was thus done with the intention of assessing the rate of compliance and factors affecting it in patients receiving ART; in order to generate baseline data for providing appropriate patient education and improve compliance.

A questionnaire-based cross-sectional study was carried out in the outpatient department (OPD) of a district hospital providing ART after approval by institutional ethics committee. Criteria for inclusion were any individual registered in the ART clinic for at least 4 weeks and willing to participate in the study. Basic sociodemographic data and data related to ART, as well as reasons for noncompliance, were recorded. Patients who missed more than 2 tablets per month were classified as nonadherent according to pill consumption criteria. A delay of more than 2 h is clinically significant and hence, patients who delayed dose for more than 2 h or those who did not consume efavirenz on an empty stomach were considered nonadherent by correct use criteria. Four hundred fifty patients who gave a voluntary consent were included in the study. It was seen that 11.12% were nonadherent by pill consumption criteria and 16% patients reported to have delayed drug administration beyond 2 h. 5.89% reported to have not taken the efavirenz on an empty stomach for at least once during the past week. Although compliance rate considering one criterion at the time ranged from 90% to 84%, clubbing of all three criteria together resulted in a drop of compliance rate to 73.55% (119 patients). Different factors affecting compliance of patients have been shown in Graph 1 [Additional file 1]. Most patients attributed their noncompliance to forgetfulness, 37 attributed it to the fact that they had not realized the importance of following the instructions rigidly.

The adherence rate in the present study was much higher than the studies where compliance rate varied between 50% and 70%. [2],[3],[4] The reason for a higher compliance in the present study could be due to the fact that our set up is made for administration of only first-line ART where number of tablets are limited, regime is simpler and protease inhibitors with reduced tolerability and adherence [5] are not a part of first-line ART. In terms of factors affecting compliance, one important difference between other studies and the present study was that the patients in our setup did understand the instructions but still failed to follow the regime as they did not realize the importance of the instructions they were asked to follow. The reason for this differential reporting might be related to the fact that being a heavy rush set up, all advices regarding pill consumption, time and dietary restrictions were given to the patients by the providers, but stress was not laid upon "Why it was important to follow instructions?" or "What would happen if instructions were not followed correctly." Reasons like "too many pills to take" or "treatment not affordable" were less in the present study because as compared to second-line ART centers providing more complicated treatment regimes with heavy pill burden, in our set up number of pills per day were ≤2 and drugs were provided free of cost. The limitations of the present study were that the results were based on patient self-report and the adherence rate by self-report was not confirmed by more objective parameters like CD4 count or viral RNA load due to time and cost constraints. Despite limitations, the present study was a sincere effort to evaluate compliance rate and identify deterrents to compliance in our set up.

Thus, it can be concluded that compliance to ART in the present set up can be favorably modified by modifying at least two important factors associated with noncompliance like forgetfulness and patients understanding the importance of following instructions carefully. Counselors laying more stress on the importance of adherence to therapy can play an important role in this regard.


  Acknowledgments Top


Our sincere thanks to ICMR for supporting this study as a short-term research project, Dr. RV Bhagvat (Head of the Department of Medicine) for his encouragement, and the entire ART OPD staff for their cooperation during the study.

 
  References Top

1.
Shah CA. Adherence to high activity antiretrovial therapy (HAART) in pediatric patients infected with HIV: Issues and interventions. Indian J Pediatr 2007;74:55-60.  Back to cited text no. 1
[PUBMED]    
2.
Battaglioli-DeNero AM. Strategies for improving patient adherence to therapy and long-term patient outcomes. J Assoc Nurses AIDS Care 2007;18:S17-22.  Back to cited text no. 2
[PUBMED]    
3.
Duran S, Spire B, Raffi F, Walter V, Bouhour D, Journot V, et al. Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clin Trials 2001;2:38-45.  Back to cited text no. 3
    
4.
Glass TR, De Geest S, Weber R, Vernazza PL, Rickenbach M, Furrer H, et al. Correlates of self-reported nonadherence to antiretroviral therapy in HIV-infected patients: The Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2006;41:385-92.  Back to cited text no. 4
    
5.
Protopopescu C, Raffi F, Roux P, Reynes J, Dellamonica P, Spire B, et al. Factors associated with non-adherence to long-term highly active antiretroviral therapy: A 10 year follow-up analysis with correction for the bias induced by missing data. J Antimicrob Chemother 2009;64:599-606.  Back to cited text no. 5
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