Adherence to antiretroviral therapy in patients participating in a graduated cost recovery program at an HIV care center in South India

In resource-constrained settings, the most frequently cited barrier to optimal antiretroviral therapy (ART) adherence among HIV-infected patients has been the cost of medications. In recent years many subsidized medication programs have been developed to improve ART affordability. A Graduated Cost Recovery program at the largest care center in South India has enrolled 839 eligible patients into four tiers based on an evaluation of their financial information and willingness to pay, of these patients 635 consented to participate in this study. Patients in Tier 1 receive first-line ART at no cost, whereas patients in Tiers 2, 3, and 4 pay 50, 75, and 100%, respectively of the cost of first-line medications based on an assessment of their means. Adherence rates of 95% or greater on 3-day recall were achieved by 84.6% of Tier 1 (n = 156), 71.6% of Tier 2 (n = 141), 72.3% of Tier 3 (n = 242), and 79.2% of Tier 4 (n = 96). These findings suggest patients are highly motivated and that the provision of no-cost ART can promote higher rates of optimal adherence.

Costs and financial burden of care and support services to PLHA and households in South India

The objective of this study is to estimate the medical and non-medical out-of-pocket expenditure on care and support services to PLHA, the financial burden on households, the indirect costs and coping strategies to meet the financial burden. A structured pre-tested questionnaire was used to collect data from a cohort of 153 clients of YRG CARE, a leading Chennai based NGO, who had completed the first and third waves of interview during 2000/01 and 2001/02 respectively. The results show that the median out-of-pocket medical and non-medical expenditures (direct cost) for treatment and services are Rs. 6,000 (US $ 122) in a reference period of six months. Clients on antiretroviral (ARV) drugs spend five times more than those not on ARV. The median direct cost significantly increases with stage of disease, household income, and poverty level. The financial burden of treatment, measured as the ratio of direct cost to household income, is greater on lower income (82%) than on higher income (28%) households. 31% and 45% of the clients reported loss of income and workdays respectively. In conclusion, the direct costs and financial burden of care and support services increase with the stage of disease. The financial burden is disproportionately more on low-income households. HIV/AIDS leads to depletion of savings and increases the indebtedness of households.

AIDS in India

Contributing factors to the epidemic are discussed and suggestions made for its management.

Stopping HIV before it begins: issues faced by women in India

Despite advances in understanding HIV pathogenesis, the economic, social and legal constraints in India continue to make women particularly vulnerable to HIV infection.

Dried blood spots (DBS): a valuable tool for HIV surveillance in developing/tropical countries

Dried blood spots (DBS) on filter paper have been used as a practical method of sample collection in sero-surveillance studies of numerous diseases. DBS may be particularly useful for HIV screening in remote areas, in which unrefrigerated transfer time to a laboratory may take a number of days. In this study, we evaluate the ability to detect human immunodeficiency virus (HIV) type-1 antibodies from DBS that have been subjected to a tropical climate in southern India for 6 days. DBS were prepared from blood samples of 59 known HIV-positive individuals and 30 known HIV-negative individuals. ELISA and Western blot results from DBS that were subjected to a mean temperature of 35.8 degrees C and humidity of 73% for 6 days had a sensitivity of 100% and 92%, respectively, and a specificity of 100% and 100%, respectively. Based on these findings, we conclude that DBS sampling could serve as a cost-effective and convenient tool for widespread HIV sero-surveillance in remote areas within tropical countries.

Prevalence and risk factors of HIV-1 and HIV-2 infection in urban and rural areas in Tamil Nadu, India

We aim to study the factors associated with the prevalence of HIV-1 and HIV-2 infection in the urban and rural areas of Tamil Nadu, India. The population of Tamil Nadu is approximately 60 million. Between April 94 and March 95, 992 samples from 5 representative urban centres and 1071 samples from 5 representative rural centres were collected and studied. A questionnaire was administered privately and it preceded collection of each sample. Samples were screened using ELISA and antibodies to HIV-1 and HIV-2 were confirmed using Western blot. The study was anonymous and unlinked. The prevalence of HIV infection in urban and rural areas was 7.2% (95% CI=6.1 to 8.31%); HIV-1 antibodies were found in 7.4% (95% CI=5.8 to 9.2%) of urban and 7.0% (95% CI=5.6 to 8.7%) of rural population; HIV-2 antibodies were found in 0.8% of urban and 0.3% of rural population. Heterosexual transmission, more so among those with multiple partner sex, was the main mode; higher prevalence of HIV infection among divorced/single individuals both in urban (21.1%) and rural (26.1%) was found. HIV infection among housewives stood at 4.1% (urban) and 3.8% (rural). The strength of association between STDs and HIV was observed to be greater in rural subjects (OR=8.89; 95% CI=5.11 to 15.57) than in urban subjects (OR=1.9; 95% CI=1.14 to 3.18). The prevalence of condom use was found to be less than 2% in the study subjects. HIV-2 is not as widely prevalent in Tamil Nadu as HIV-1. In our study the most common risk factors for HIV infection that emerged were (a) having multiple sexual partners, and (b) history of STDs or Venereal Disease Research Laboratory (VDRL) reactivity. Mobility of individuals between urban and rural areas has furthered the dissemination of HIV infection. Low condom usage among study subjects questions the effectiveness of the existing AIDS awareness and education programme. The study indicates the importance of placing equal emphasis on HIV prevention in rural India. HIV infection among housewives in urban and rural areas is indicative of gender inequalities and the importance of empowering women to prevent infection from spouse.