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CME Table of Contents   
Year : 2013  |  Volume : 38  |  Issue : 2  |  Page : 74-82
Adherence to antiretroviral therapy in India: A systematic review and meta-analysis


1 Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South; Clinical and Translational Science Institute, University of South Florida, Florida, USA
2 Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Florida, USA
3 Clinical and Translational Science Institute, University of South; Department of Pediatrcis, Morsani College of Medicine, University of South Florida, Florida, USA
4 Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South; Clinical and Translational Science Institute, University of South; Moffitt Cancer Center, Tampa, Florida, USA
5 Department of Preventive and Social Medicine, Government Medical College, Vadodara, Gujrat, India
6 Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Florida, USA

Correspondence Address:
Ambuj Kumar
Department of Internal Medicine, Division and Center for Evidence Based Medicine and Outcomes Research, Morsani College of Medicine, University of South Florida, Clinical and Translational Science Institute, 12901 Bruce B Downs Blvd, MDC 27, Tampa, FL
USA
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Source of Support: None, Conflict of Interest: All authors [RM,VA,PE,BD,SP,AP,EN,SM,AK] declare that they have no non-financial interests that may be relevant to the submitted work. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.


DOI: 10.4103/0970-0218.112435

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Objective: To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India. Design: Systematic review and meta-analysis. Materials and Methods: The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model. Results: There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (P = 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59-81%, I 2 = 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor. Conclusion: Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.


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