Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinics in Mumbai, India

Background. Adherence to antiretroviral therapy ( ART) and correlates of adherence and virologic suppression among human immunodeficiency virus (HIV)-infected persons receiving ART in private, outpatient clinics in India is unknown. Methods. Between December 2004 and April 2005, persons receiving ART at 3 private clinics in Mumbai, India, were interviewed regarding HIV care and adherence to ART. Physicians also completed a survey for each participant. Quantitative HIV-1 RNA level was determined for 200 participants. Results. Of 279 participants, 73% reported >= 95% adherence to ART. Adherence was positively associated with age >= 50 years ( adjusted odds ratio [aOR], 3.90), presence of comorbid conditions ( aOR, 1.92), medication self-efficacy ( aOR, 4.01), absence of pain in the past month ( aOR, 2.14), and support from family and friends ( aOR, 2.57). Lack of reminders from family members to take medication ( aOR, 0.27) was negatively associated with adherence. Of 200 participants, 127 (63.5%) had virologic suppression ( RNA level, < 400 copies/mL). Independent correlates of suppression were a regimen containing >= 3 ART drugs (aOR, 5.52), first ART regimen ( aOR, 3.28), adherence to therapy >= 95% (aOR, 5.70), female sex (aOR, 3.19), and a physical component score >= 50 (aOR, 1.07). Conclusion. Self-reported adherence to ART in a sample of patients attending Mumbai's private clinics was relatively high. However, the fact that a detectable viral level was found in nearly 40% of patients suggests that second-line ART regimens, as well as an emphasis on adherence and appropriate ART regimens in India, is needed.