Preprint / Version 1

Why are HIV-infected people not started on antiretroviral therapy? A mixed-methods study from Gujarat, India

Authors

  • S Chawla Gujarat State AIDS Control Society, Health and Family Welfare Department, Government of Gujarat, Ahmedabad, India
  • K Shringarpure Department of Community Medicine, Government Medical College and SSG Hospital, Vadodara, India
  • B Modi Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, India
  • R Sharma Department of Community Medicine, GMERS Medical College, Sola, Ahmedabad, India
  • B Rewari World Health Organization India Country Office, New Delhi, India
  • A Shah Department of Medicine, BJ Medical College and Civil Hospital, Ahmedabad, India
  • P Verma Gujarat State AIDS Control Society, Health and Family Welfare Department, Government of Gujarat, Ahmedabad, India
  • A Dongre Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
  • A Kumar International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India

Keywords:

National AIDS Control Programme, ART-eligible, operational research, 90–90–90, SORT IT

Abstract

Setting: Five purposively selected antiretroviral therapy (ART) centres in Gujarat, India. Objectives: To assess the proportion of ART-eligible people living with the human immunodeficiency virus (PLHIV) who were not initiated on ART within 2 months of being recorded as eligible, to identify factors associated with non-initiation and to explore reasons from the provider's perspective. Design: We used a mixed-methods design (triangulation) of 1) a quantitative phase involving record reviews and cohort analysis (Poisson regression) of PLHIV registered during April 2014–March 2015, and 2) a qualitative phase involving one-to-one interviews with 25 providers. Results: Of 2079 ART-eligible PLHIV, 339 (16%) were not started on ART within 2 months. PLHIV with CD4 counts of <350 cells/μl and patients who were labourers, hospitalised, bedridden or registered with certain ART centres were more likely not to be initiated on ART. Qualitative results were categorised into two broad themes: government health system- and patient-related challenges, which validated and complemented the quantitative findings. Conclusion: Several patient subgroups at greater risk of ART non-initiation were identified, along with reasons for risk; this has important programme implications for achieving the UNAIDS 90–90–90 goal, and particularly the second 90 component of having 90% of diagnosed PLHIV start ART. Keywords: National AIDS Control Programme, ART-eligible, operational research, 90–90–90, SORT IT

Author Biographies

P Verma, Gujarat State AIDS Control Society, Health and Family Welfare Department, Government of Gujarat, Ahmedabad, India

Department of Community Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, India

A Kumar, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India

The Union, Paris, France

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