Does providing free antiretroviral therapy ensure optimal adherence among people living with human immunodeficiency virus/acquired immunodeficiency syndrome?

Objective: The present study was carried out with the objective of determining the level of adherence and factors affecting it among patients receiving free antiretroviral therapy (ART). Methods: A cross-sectional study design was adopted and 320 human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome positive patients receiving free ART from a district hospital in Udupi were interviewed using a semi-structured questionnaire. Adherence to ART >95% of the prescribed medication was used as the cutoff for deciding on the treatment adherence. Results: An encouragingly high 96.9% of the individuals were adherent to the medication over the past month. However, 41.8% of the participants reported to have ever missed doses of ART. On univariate analysis, having ever consumed alcohol, absence of side effects such as fatigue and tingling/ numbness, having a feeling of sadness and sleep disturbances, being on efavirenz-based regimen, non-disclosure HIV status, being unsure of continuing lifelong treatment were significantly associated with non-adherence (p<0.05). Conclusion: Although non-adherence was of concern among a small proportion of participants, a large number of them reported to have ever missed doses of ART. This finding suggests that adherence rate may be lower over longer periods of time. Hence, periodic assessments may address patient specific barriers and help to improve the adherence rate among this population.