There is a need to focus on 100% adherence particularly in antiretroviral therapy (ART) for HIV treatment said an expert at a panel discussion on adherence to treatment protocols on Wednesday.
Dr Rajesh Gopal, additional project director, Gujarat State Aids Control Society (GSACS) said that adherence is the single most important thing in ART. "Technically an adherence of 95% is also considered a gold standard in ART treatment but it is important to have 100% adherence. The adherence is insisted on to ensure that the virus is suppressed and is brought to a level that it is not detectable and it cannot be transferred to others via the patient. But we have found that even with 95% adherence to the ART the virus was completely suppressed in only 81% of the cases," said Dr Gopal.
He said with India, there are unique problems as to why adherence to treatment is not maintained. "We have come across cases where patients sometimes skip taking medicine because they are fasting. In some cases they are afraid of side effects," said Dr Gopal. He added that sometimes the time provided by doctors and counsellors to such patients also has an impact on how well they adhere to the treatment that they have to undergo.
Jyoti Raut, president, Parivartan Foundation working with Gujarat State Network of People Living with HIV (GSNP+) said that from the patient perspective adherence to a drug regime was often affected by nutrition and financial troubles faced by a patient too. "Take for example the case of patients who are young orphans and have to be regularly taken to hospitals for follow up visits. Sometimes there is no one to take them. For some families, the ART centres are too far and it is not possible for them to spend money on transportation and travel so far which sometimes affect how doggedly they follow a drug regimen for HIV treatment," said Raut.
She said the government also offers some aid to those who are undergoing treatment for HIV but many times these aids don't reach the patients leading to mistrust and also affecting adherence.
Explaining why taking therapy regularly was important from an economic perspective too Viswanath Pingali, faculty of Economics with IIMA said that loss of productivity amounted to a large percentage of the total cost of Tuberculosis treatment. "Loss of productivity amounted to 30% to 40% of the total cost of TB," said Pingali.
