Adherence to antiretroviral therapy among patients participating in a graduated cost recovery program at an HIV clinic in South India

Background:

Although antiretroviral treatment (ART) availability in resource-constrained settings has improved because of cheaper generic medications, many patients still identify cost as a major barrier to optimal adherence. This study is aimed at exploring the role of medication subsidies in addressing this barrier.

Methods:

HIV-infected adult patients receiving care at YRGCARE, an HIV ambulatory clinic in South India, were enrolled in a graduated cost recovery program based on their socioeconomic status and their ability to pay. Tier 1 patients received cost-free ART, whereas Tier 2, Tier 3, and Tier 4 patients contributed 25%, 50%, or 100%, respectively, to their medication costs.

Participants were asked 3-day dose recall during quarterly appointments scheduled between February and May 2007. Adequate adherence was defined as taking at least 95% of all prescribed doses during the recall period. All data was analyzed using SPSS software (version 13.0).

Results:

In total, 635 individuals participated. The mean age was 39 years and75.7% of the cohort was male. Adherence was highest for Tier 1 participants (84.6%), and, among those paying part of their medication costs, adherence rates increased with percentage contribution: Tier 2, (71.6%) < Tier 3 (72.3%) < Tier 4 (79.2%); p=0.02.

Conclusions:

Providing cost-free ART to poor patients can significantly increase adherence to levels that exceed those seen in patients paying full-price and in patients receiving medication subsidies.