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Relationships Among Adherence and Physical and Mental Health Among Women Living with HIV in Rural India

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Abstract

We conducted a cross-sectional examination of the physical and psychological factors related to ART adherence among a sample of 400 women living with HIV/AIDS in rural India. Interviewer-administered measures assessed adherence, internalized stigma, depressive symptoms, quality of life, food insecurity, health history and sociodemographic information. CD4 counts were measured using blood collected at screening. Findings revealed that adherence to ART was generally low, with 94% of women taking 50% or less of prescribed medication in past month. Multivariate analyses showed a non-linear association between numbers of self-reported opportunistic infections (OIs) in past 6 months (p = 0.016) and adherence, with adherence decreasing with each additional OI for 0–5 OIs. For those reporting more than 5 OIs, the association reversed direction, with increasing OIs beyond 5 associated with greater adherence.

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References

  1. Joint United Nations Programme on HIV/AIDS. The GAP Report. Geneva: UNAIDS; 2014.

    Google Scholar 

  2. Dandona L, Dandona R, Gutierrez JP, Kumar GA, McPherson S, Bertozzi SM. Sex behaviour of men who have sex with men and risk of HIV in Andhra Pradesh, India. AIDS. 2005;19(6):611–9.

    Article  PubMed  Google Scholar 

  3. Dandona R, Dandona L, Gutierrez JP, et al. High risk of HIV in non-brothel based female sex workers in India. BMC Public Health. 2005;5:87.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dandona R, Dandona L, Kumar GA, Gutierrez JP, McPherson S, Bertozzi SM. HIV testing among female sex workers in Andhra Pradesh, India. AIDS. 2005;19(17):2033–6.

    Article  PubMed  Google Scholar 

  5. Brahmam GN, Kodavalla V, Rajkumar H, et al. Sexual practices, HIV and sexually transmitted infections among self-identified men who have sex with men in four high HIV prevalence states of India. AIDS. 2008;22(Suppl 5):S45–57.

    Article  PubMed  Google Scholar 

  6. Talukdar A, Khandokar MR, Bandopadhyay SK, Detels R. Risk of HIV infection but not other sexually transmitted diseases is lower among homeless Muslim men in Kolkata. AIDS. 2007;21(16):2231–5.

    Article  PubMed  Google Scholar 

  7. Marfatia YS, Naik E, Singhal P, Naswa S. Profile of HIV seroconcordant/discordant couples a clinic based study at Vadodara India. Indian J Sex Transm Dis. 2013;34(1):5–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Savini CJ, James CW, DiGuglielmo DJ. Survey of patient and clinician attitudes on adherence in a rural HIV clinic. J Assoc Nurses AIDS Care. 2003;14(3):72–5.

    Article  PubMed  Google Scholar 

  9. Moir S, Buckner CM, Ho J, et al. B cells in early and chronic HIV infection: evidence for preservation of immune function associated with early initiation of antiretroviral therapy. Blood. 2010;116(25):5571–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Kumarasamy N, Safren SA, Raminani SR, et al. Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study. AIDS Patient Care STDS. 2005;19(8):526–37.

    Article  CAS  PubMed  Google Scholar 

  11. Batavia AS, Balaji K, Houle E, et al. Adherence to antiretroviral therapy in patients participating in a graduated cost recovery program at an HIV care center in South India. AIDS Behav. 2010;14(4):794–8.

    Article  PubMed  Google Scholar 

  12. Venkatesh KK, Srikrishnan AK, Mayer KH, et al. Predictors of nonadherence to highly active antiretroviral therapy among HIV-infected South Indians in clinical care: implications for developing adherence interventions in resource-limited settings. AIDS Patient Care STDS. 2010;24(12):795–803.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kleinman NJ, Manhart LE, Mohanraj R, et al. Antiretroviral therapy adherence measurement in non-clinical settings in South India. AIDS Care. 2015;27(2):248–54.

    Article  PubMed  Google Scholar 

  14. Ekstrand ML, Chandy S, Heylen E, Steward W, Singh G. Developing useful highly active antiretroviral therapy adherence measures for India: the Prerana study. J Acquir Immune Defic Syndr. 2010;53(3):415–6.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ekstrand ML, Shet A, Chandy S, et al. Suboptimal adherence associated with virological failure and resistance mutations to first-line highly active antiretroviral therapy (HAART) in Bangalore, India. Int Health. 2011;3(1):27–34.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Vallabhaneni S, Chandy S, Heylen E, Ekstrand M. Reasons for and correlates of antiretroviral treatment interruptions in a cohort of patients from public and private clinics in southern India. AIDS Care. 2012;24(6):687–94.

    Article  PubMed  Google Scholar 

  17. Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clin Infect Dis. 2002;34(8):1115–21.

    Article  PubMed  Google Scholar 

  18. Byakika-Tusiime J, Crane J, Oyugi JH, et al. Longitudinal antiretroviral adherence in HIV + Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time. AIDS Behav. 2009;13(Suppl 1):82–91.

    Article  PubMed  Google Scholar 

  19. Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr. 2007;45(3):334–41.

    PubMed  Google Scholar 

  20. Sinha G, Peters DH, Bollinger RC. Strategies for gender-equitable HIV services in rural India. Health Policy Plan. 2009;24(3):197–208.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Anderson SA. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(11):1559–99.

    Google Scholar 

  22. Hardon AP, Akurut D, Comoro C, et al. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19(5):658–65.

    Article  CAS  PubMed  Google Scholar 

  23. Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009;63(4):636–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Sabin LL, Desilva MB, Hamer DH, et al. Barriers to adherence to antiretroviral medications among patients living with HIV in southern China: a qualitative study. AIDS Care. 2008;20(10):1242–50.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Joshi B, Chauhan S, Pasi A, et al. Level of suboptimal adherence to first line antiretroviral treatment & its determinants among HIV positive people in India. Indian J Med Res. 2014;140(1):84–95.

    PubMed  PubMed Central  Google Scholar 

  26. Cauldbeck MB, O’Connor C, O’Connor MB, et al. Adherence to anti-retroviral therapy among HIV patients in Bangalore, India. AIDS Res Ther. 2009;6:7.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Messer LC, Pence BW, Whetten K, et al. Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries. BMC Public Health. 2010;10:504.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Spaar A, Graber C, Dabis F, et al. Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings. AIDS Care. 2010;22(6):775–83.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Norman A, Chopra M, Kadiyala S. Factors related to HIV disclosure in 2 South African communities. Am J Public Health. 2007;97(10):1775–81.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Patel SV, Patel SN, Baxi RK, et al. HIV serostatus disclosure: experiences and perceptions of people living with HIV/AIDS and their service providers in Gujarat, India. Ind Psychiatry J. 2012;21(2):130–6.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sarna A, Sebastian M, Bachani D, Sogarwal R, Battala M. Pretreatment loss-to-follow-up after HIV diagnosis from 27 counseling and testing centers across India: findings from a cohort study. J Int Assoc Provid AIDS Care. 2014;13(3):223–31.

    Article  PubMed  Google Scholar 

  32. Ekstrand ML, Ramakrishna J, Bharat S, Heylen E. Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. J Int AIDS Soc. 2013;16(3 Suppl 2):18717.

    PubMed  PubMed Central  Google Scholar 

  33. Madi D, Gupta P, Achappa B, et al. HIV status disclosure among people living with HIV in the era of combination antiretroviral therapy (cART). J Clin Diagn Res. 2015;9(8):14–6.

    Google Scholar 

  34. Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma is associated with delays in seeking care among HIV-Infected people in India. J Int Assoc Phys AIDS Care (Chicago, Ill.: 2002). 2012;12:103–9.

    Article  Google Scholar 

  35. Dworkin MS, Douglas GW, Sabitha Rani GP, Chakraborty A. Adherence to highly active antiretroviral therapy in Hyderabad, India: barriers, facilitators and identification of target groups. Int J STD AIDS. 2016;27(3):186–95.

    Article  CAS  PubMed  Google Scholar 

  36. Harries AD, Nyangulu DS, Hargreaves NJ, Kaluwa O, Salaniponi FM. Preventing antiretroviral anarchy in sub-Saharan Africa. Lancet. 2001;358(9279):410–4.

    Article  CAS  PubMed  Google Scholar 

  37. Nemes MI, Carvalho HB, Souza MF. Antiretroviral therapy adherence in Brazil. AIDS. 2004;18(Suppl 3):S15–20.

    Article  PubMed  Google Scholar 

  38. Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, Dam J. Adherence to antiretroviral therapy & its determinants amongst HIV patients in India. Indian J Med Res. 2008;127(1):28–36.

    CAS  PubMed  Google Scholar 

  39. Cook JA, Burke-Miller JK, Grey DD, et al. Do HIV-positive women receive depression treatment that meets best practice guidelines? AIDS Behav. 2014;18(6):1094–102.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tsai AC, Hung KJ, Weiser SD. Is food insecurity associated with HIV risk? Cross-sectional evidence from sexually active women in Brazil. PLoS Med. 2012;9(4):e1001203.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Weiser SD, Palar K, Frongillo EA, et al. Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS. 2014;28(1):115–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Tsai AC, Bangsberg DR, Frongillo EA, et al. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012;74(12):2012–9.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Vogenthaler NS, Hadley C, Rodriguez AE, Valverde EE, del Rio C, Metsch LR. Depressive symptoms and food insufficiency among HIV-infected crack users in Atlanta and Miami. AIDS Behav. 2011;15(7):1520–6.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Heylen E, Panicker ST, Chandy S, Steward WT, Ekstrand ML. Food insecurity and its relation to psychological well-being among south indian people living with HIV. AIDS Behav. 2015;19(8):1548–58.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Nyamathi AM, William RR, Ganguly KK, et al. Perceptions of women living with AIDS in rural India related to the engagement of HIV-trained accredited social health activists for care and support. J HIV AIDS Soc Serv. 2010;9(4):385–404.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Nyamathi AM, Sinha S, Ganguly KK, et al. Challenges experienced by rural women in India living with AIDS and implications for the delivery of HIV/AIDS care. Health Care Women Int. 2011;32(4):300–13.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Nyamathi A, Hanson AY, Salem BE, et al. Impact of a rural village women (Asha) intervention on adherence to antiretroviral therapy in southern India. Nurs Res. 2012;61(5):353–62.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Nyamathi A, Salem B, Meyer V, Ganguly K, Sinha S, Ramakrishnan P. Impact of an ASHA intervention on depressive symptoms among rural women living with AIDS in India: comparison of the ASHA life and usual care program. AIDS Educ Prev. 2012;24(3):280–93.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Nyamathi A, Ekstrand M, Salem BE, Sinha S, Ganguly KK, Leake B. Impact of Asha intervention on stigma among rural Indian women with AIDS. West J Nurs Res. 2013;35(7):867–83.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Nischal KC, Khopkar U, Saple DG. Improving adherence to antiretroviral therapy. Indian J Dermatol Venereol Leprol. 2005;71(5):316–20.

    Article  CAS  PubMed  Google Scholar 

  51. Langebeek N, Gisolf EH, Reiss P, et al. Predictors and correlates of adherence to combination antiretroviral therapy (ART) for chronic HIV infection: a meta-analysis. BMC Med. 2014;12:142.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Steward WT, Chandy S, Singh G, et al. Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India. Psychol Health Med. 2011;16(1):74–85.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5(2):74–9.

    Article  PubMed  Google Scholar 

  54. Ekstrand M, Solomon D, Gopalkrishnan S, Krishnan AK, Kumarasamy N. Alcohol use, partner violence and sexual risk among south India female sex workers: implications for interventions. In: 2nd International Conference on Alcohol and HIV. New Delhi 2010.

  55. Ekstrand ML, Bharat S, Ramakrishna J, Heylen E. Blame, symbolic stigma and HIV misconceptions are associated with support for coercive measures in urban India. AIDS Behav. 2012;16(3):700–10.

    Article  PubMed  Google Scholar 

  56. Radloff L. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.

    Article  Google Scholar 

  57. Nyamathi A, Heravian A, Zolt-Gilburne J, et al. Correlates of depression among rural women living with AIDS in Southern India. Issues Ment Health Nurs. 2011;32(6):385–91.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Zhang W, O’Brien N, Forrest JI, et al. Validating a shortened depression scale (10 item CES-D) among HIV-positive people in British Columbia, Canada. PLoS ONE. 2012;7(7):e40793.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Endicott J, Nee J, Harrison W, Blumenthal R. Quality of life enjoyment and satisfaction questionnaire: a new measure. Psychopharmacol Bull. 1993;29(2):321–6.

    CAS  PubMed  Google Scholar 

  60. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for measurement of household food access: indicator guide (v.3). Washington. 2007.

  61. Potchoo Y, Tchamdja K, Balogou A, Pitche VP, Guissou IP, Kassang EK. Knowledge and adherence to antiretroviral therapy among adult people living with HIV/AIDS treated in the health care centers of the association “Espoir Vie Togo” in Togo, West Africa. BMC Clin Pharmacol. 2010;10:11.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Lyimo RA, Stutterheim SE, Hospers HJ, de Glee T, van der Ven A, de Bruin M. Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania. AIDS Patient Care STDS. 2014;28(2):98–105.

    Article  PubMed  Google Scholar 

  63. Bam K, Rajbhandari RM, Karmacharya DB, Dixit SM. Strengthening adherence to anti retroviral therapy (ART) monitoring and support: operation research to identify barriers and facilitators in Nepal. BMC Health Serv Res. 2015;15:188.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Shet A, Decosta A, Heylen E, Shastri S, Chandy S, Ekstrand M. High rates of adherence and treatment success in a public and public-private HIV clinic in India: potential benefits of standardized national care delivery systems. BMC Health Serv Res. 2011;11:277.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Nyamathi A, Salem B, Ernst E, Keenan C, Suresh P, Sinha S, Ganguly K, Ramakrishnan P, Liu Y. Correlates of adherence among rural indian women living with HIV/AIDS. J HIV/AIDS Soc Serv. 2012;11:327–45.

    Article  Google Scholar 

  66. Chow JY, Alsan M, Armstrong W, del Rio C, Marconi VC. Risk factors for AIDS-defining illnesses among a population of poorly adherent people living with HIV/AIDS in Atlanta, Georgia. AIDS Care. 2015;27(7):844–8.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Pinoges L, Schramm B, Poulet E, et al. Risk factors and mortality associated with resistance to first-line antiretroviral therapy: multicentric cross-sectional and longitudinal analyses. J Acquir Immune Defic Syndr. 2015;68(5):527–35.

    Article  CAS  PubMed  Google Scholar 

  68. Kelly JD, Hartman C, Graham J, Kallen MA, Giordano TP. Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study. J Assoc Nurses AIDS Care. 2014;25(5):405–13.

    Article  PubMed  PubMed Central  Google Scholar 

  69. World Health Organization. Health sector response to HIV in the South-East Asia region. India: New Delhi; 2013.

    Google Scholar 

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Acknowledgements

This study was funded by the National Institute on Mental Health NIMH098729-01.

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Authors and Affiliations

  1. School of Nursing, University of California, Room 2-250, Factor Building, Los Angeles, CA, 90095-1702, USA

    Adeline Nyamathi, Kartik Yadav & Catherine L. Carpenter

  2. Center for AIDS Prevention Studies, University of California, San Francisco, USA

    Maria Ekstrand & Elsa Heylen

  3. People’s Health Society, Nellore, India

    Padma Ramakrishna

  4. Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India

    Sanjeev Sinha

  5. School of Medicine, Cal State University, Los Angeles, USA

    Angela Hudson

  6. School of Medicine, University of California, Los Angeles, USA

    Lenore Arab

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  1. Adeline Nyamathi
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  2. Maria Ekstrand
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Correspondence to Adeline Nyamathi.

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Ethical approval for the study was obtained by UCLA’s Institutional Review Board and AIIMS Ethical Review Committee.

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Nyamathi, A., Ekstrand, M., Heylen, E. et al. Relationships Among Adherence and Physical and Mental Health Among Women Living with HIV in Rural India. AIDS Behav 22, 867–876 (2018). https://doi.org/10.1007/s10461-016-1631-3

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