AIDS and Behavior

, Volume 14, Issue 4, pp 794–798 | Cite as

Adherence to Antiretroviral Therapy in Patients Participating in a Graduated Cost Recovery Program at an HIV Care Center in South India

  • Ashita S. Batavia
  • Kavitha Balaji
  • Elizabeth Houle
  • Sangeetha Parisaboina
  • A. K. Ganesh
  • Kenneth H. MayerEmail author
  • Suniti Solomon
Original Paper


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.


Antiretroviral therapy India HIV Costs Adherence 



Sources of Financial Support: The authors would like to thank the Brown/Tufts Fogarty International Clinical Research and Scholars Program, D43 TW000237-14S1 and the National Institute of Health for their supporting this study.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Ashita S. Batavia
    • 1
  • Kavitha Balaji
    • 2
  • Elizabeth Houle
    • 3
  • Sangeetha Parisaboina
    • 2
  • A. K. Ganesh
    • 2
  • Kenneth H. Mayer
    • 4
    Email author
  • Suniti Solomon
    • 2
  1. 1.Weill/Cornell Medical CollegeNew YorkUSA
  2. 2.YRG CAREChennaiIndia
  3. 3.Department of MedicineJohns Hopkins HospitalBaltimoreUSA
  4. 4.Department of MedicineBrown Medical School/Miriam HospitalProvidenceUSA

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