Socio-Demographic, Clinical Predictors and Economic Barriers of ART Adherence Among PLHIV of Western India - a cross-sectional study

Background: Anti-Retroviral Therapy (ART) drugs adherence is essential for achieving viral suppression, yet barriers persist affecting its adherence particularly in high migrant and overpopulation area of South Gujarat, India. Aim: To identify factors of poor ART adherence. Methodology: A cross-sectional study was conducted to identify the barriers of good ART adherence at ART Centre, Surat over 1 year; PLHIV (n=240) using pre- tested, semi-structured questionnaire. Results: Middle-aged: 36–55 yrs (56.25%), males (56.7%), illiterate (36.7%), interstate migrants (70%), poor social support (33.3%), non-disclosure of HIV status (10.4%), and side effects (16.25%) showed poor adherence, higher viral load, and low CD4 counts. Economic barriers: average loss of wages Rs. 455/- per visit and 45-60min travel time to visit ART centre. There was significant difference between mean + SD of CD4 count & duration of treatment (p=0.038), adherence & side effects (p=0.003), adherence & last viral load (p=0.001). High viral load is associated with lower adherence (r= -0.319, p=0.025). Travel and social events, communication gaps, geographic inaccessibility, fear of discrimination, false sense of security, job insecurity decreases adherence. Conclusion: Causes of poor adherence are migration, economic loss, side effects and lack of social support. Interventions like single long-acting drug, multi month dispensing may help in improving adherence.