Article

Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis

Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Florida, USA
Indian Journal of Community Medicine 04/2013; 38(2):74-82. DOI: 10.4103/0970-0218.112435
Source: PubMed

ABSTRACT To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.
Systematic review and meta-analysis.
The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.
There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (P = 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59-81%, I(2) = 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor.
Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.

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    • "Another meta-analysis in 2011, for Spanish patients on Highly Active Antiretroviral Therapy which dichotomized adherence at >90 and employed several methods for measuring adherence showed that 48.7% of the patients were adherent based on self-report with an overall percentage adherence of 55% (Ortego et al., 2011). A recent meta-analysis in 2013 for Indian patients on ART reported adherence of 77% (95% CI = 59% -81%), (Mhaskar et al., 2013). 50% of the studies use in the analysis by 'Mhaskar et al' reported cost of medication as the most common obstacle for ART adherence in India. "
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