Missed and Lost to Follow-up Cases in HIV Positive Patients and the Impact of Lockdown During COVID-19 Pandemic on Adherence to Anti-retroviral Therapy at ART Center, Jhansi, Uttar Pradesh
Keywords:Humans, HIV Infections, Cross- Sectional Studies, Rehabilitation, Vocational, Lost to Follow-Up, Pandemics, Counseling, Informed Consent, Fear, Surveys and Questionnaires
Background: Anti-retroviral therapy (ART) for HIV has changed a highly fatal disease to a chronic manageable condition. National technical guidelines by NACO say that adherence of >95%(optimal) is required for optimal viral load suppression which is a challenge both for the patient and the health system.
Objectives: This study was conducted to determine the reasons for missed and lost to follow-up (LFU) cases and to assess the impact of the COVID pandemic on ART adherence.
Settings and Design: Cross-sectional study conducted at ART center, Jhansi.
Methods and Material: 357 patients were administered a self-designed questionnaire after taking informed consent to enquire about the reasons for missing doses and LFU and whether they missed treatment during the lockdown.
Statistical analysis used: the results were expressed in frequencies and percentages and appropriate statistical tests were applied.
Results: 72% HIV patients had optimal adherence and 6.7% were on second-line treatment. Out of 357 patients, 56 had missed treatment and 10 were LFU. The main reasons for the missing were run out of pills, busy with other things and being away from home. The number of episodes of missed and LFU increased during the pandemic. The main problems faced were lack of transport (24), fear of catching the disease (7), no money to hire a vehicle (5).
Conclusions: Constant monitoring and handholding of those with suboptimal adherence is required. Travel allowance to such patients and regular counseling will help to ensure adherence. Long-term solutions include vocational rehabilitation and awareness programs to reduce stigma and discrimination.
National AIDS Control Organization & ICMR-National Institute of Medical Statistics (2020). India HIV Estimates 2019: Report. New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. pages-xxii-xxiii Available from:URL:https://www.aidsdatahub.org/sites/default/files/ resource/india-hiv-estimates-2019.pdf
Government of India, , Annual Report 2019-20, Ministry of Health and Family Welfare Nirman Bhawan, New Delhi, chapter 24,page-425. Available from:URL: https://main.mohfw.gov.in/ sites/default/files/Annual%20Report%202019-2020%20English. pdf
National AIDS Control Organization, National Technical Guidelines on Anti-Retroviral Treatment.2018, New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. Available from:URL: https://lms.naco.gov.in/ frontend/content/NACO%20-%20National%20Technical%20 Guidelines%20on%20ART_October%202018%20(1).pdf
National AIDS Control Organization (2021). Sankalak: Status of National AIDS Response (Third edition, 2021). New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. Availablefrom:URL:http://naco.gov.in/sites/default/files/ Sankalak_Booklet_2021_Thi rd_Edition.pdf
Mhaskar R, Alandikar V, Emmanuel P, Djulbegovic B, Patel S, Patel A, et al. Adherence to Antiretroviral Therapy in India: A Systematic Review and Meta-Analysis. Indian J Community Med. 2013;38(2):74-82. doi: 10.4103/0970-0218.112435
National AIDS Control Organization , Operational guidelines for ART centers.-2012 Ministry of Health and Family Welfare, Government of India. (page 1,51) Availablefrom:URL:http://naco. gov.in/sites/default/files/Operational%20guidelines%20for%20 ART%20services.pdf
Chakravarty J, Tiwary NK, Prasad SR, Shukla S, Tiwari A , Mishra RN, et al. Determinants of survival in adult HIV patients on antiretroviral therapy in Eastern Uttar Pradesh: A prospective study. Indian J Med Res 2014 Oct; 140(4): 491–500 PMCID: PMC4277134
Mehta KG, Baxi R, Patel S, Parmar M. Drug adherence rate and loss to follow-up among people living with HIV/AIDS attending an ART Centre in a Tertiary Government Hospital in Western India. J Family Med Prim Care. 2016;5(2):266-269. doi: 10.4103/2249-4863.192325.
Achappa B, Madi D, Bhaskaran U, Ramapuram JT, Rao S, Mahalingam S. Adherence to Antiretroviral Therapy Among People Living with HIV. N Am J Med Sci. 2013;5(3):220-3. DOI: 10.4103/1947-2714.109196
Shukla M, Agarwal M, Singh JV, Tripathi AK, Srivastava AK, Singh VK. Nonadherence to Antiretroviral Therapy Among. People Living with HIV/AIDS Attending Two Tertiary Care Hospitals in District of Northern India. Indian Journal of Community Medicine: 2016 ;41(1):55-61.doi: 10.4103/0970-0218.170970
Hasabi IS, Shivashankarappa AB, Kachapur C, Kaulgud RS. A Study of Compliance to Antiretroviral Therapy among HIV Infected Patients at a Tertiary Care Hospital in North Karnataka. J Clin Diagn Res. 2016;10(5):OC27-31. doi: 10.7860/ JCDR/2016/17948.7792.
Zhou J, Tanuma J, Chaiwarith R, Lee CK, Law MG, Kumarasamy N, et al.Loss to Followup in HIV-Infected Patients from Asia-Pacific Region: Results from TAHOD. AIDS Res Treat. 2012.10 doi: 10.1155/2012/375217.
Birhanu, M.Y., Leshargie, C.T., Alebel, A. et al. Incidence and predictors of loss to follow-up among HIV-positive adults in northwest Ethiopia: a retrospective cohort study. Trop Med Health 48, 78 (2020). https://doi.org/10.1186/s41182-020-00266-z
National AIDS Control Organization (2020). Sankalak: Status of National AIDS Response (Second edition, 2020). New Delhi: NACO, Ministry of Health and Family Welfare, Government of India. Available from:URL: http://naco.gov.in/sites/default/ files/Sankalak%20Status%20of%20National%20AIDS%20 Response,%20Second%20Edition%20(2020).pdf
How to Cite
Copyright (c) 2023 Sudha Sharma, Ram Babu Singh, Anil Kumar Malhotra
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.