Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context
Summary: Background: India's free antiretroviral therapy (ART) programme was initiated in 2004. People living with HIV who were registered with ART centres (ARTC) were initiated on ART based on the CD4 count cutoffs as per prevailing guidelines. The others with higher counts remained on six-mo...
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2025-03-01
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| author | Shweta Chidrawar Suvarna Sane Megha Mamulwar Shilpa Bembalkar Rachna Thakur Tarun Bhatnagar Srikanth P. Tripathy Shrinivasa B. Marinaik Damodar Sahu Subrata Biswas Shanta Datta Yogesh Sabde Rajnarayan Tiwari Deepak Khismatrao Bhawani Singh Kushwaha Anoop Kumar Puri Chinmoyee Das Sheela V. Godbole Sheela Godbole Megha Mamulwar Suvarna Sane Shilpa Bembalkar Shweta Chidrawar Rachana Thakur Deepak Khismatrao Tarun Bhatnagar Srikanth P. Tripathy P.K. Bhavani B.M. Shrinivasa Damodar Sahu S. Dutta Subrata Biswas Rajnarayan R. Tiwari Yogesh Sabde Chinmoyee Das Bhawani Singh Kushwaha Anoop Kumar Puri Samiran Panda Smita Kulkarni Manisha Ghate Radhika Brahme Rajesh Yadav Amit Nirmalkar Shradha Gurav D.C.S. Reddy Yujwal Raj Manoj Murhekar K. Boopathi M. Vishnu Vardhana Rao Arvind Pandey Saritha Nair Indrani Gupta Avantika Ranjan Naresh Goel R.S. Gupta Manish Bamrotiya Neha Garg |
| author_facet | Shweta Chidrawar Suvarna Sane Megha Mamulwar Shilpa Bembalkar Rachna Thakur Tarun Bhatnagar Srikanth P. Tripathy Shrinivasa B. Marinaik Damodar Sahu Subrata Biswas Shanta Datta Yogesh Sabde Rajnarayan Tiwari Deepak Khismatrao Bhawani Singh Kushwaha Anoop Kumar Puri Chinmoyee Das Sheela V. Godbole Sheela Godbole Megha Mamulwar Suvarna Sane Shilpa Bembalkar Shweta Chidrawar Rachana Thakur Deepak Khismatrao Tarun Bhatnagar Srikanth P. Tripathy P.K. Bhavani B.M. Shrinivasa Damodar Sahu S. Dutta Subrata Biswas Rajnarayan R. Tiwari Yogesh Sabde Chinmoyee Das Bhawani Singh Kushwaha Anoop Kumar Puri Samiran Panda Smita Kulkarni Manisha Ghate Radhika Brahme Rajesh Yadav Amit Nirmalkar Shradha Gurav D.C.S. Reddy Yujwal Raj Manoj Murhekar K. Boopathi M. Vishnu Vardhana Rao Arvind Pandey Saritha Nair Indrani Gupta Avantika Ranjan Naresh Goel R.S. Gupta Manish Bamrotiya Neha Garg |
| author_sort | Shweta Chidrawar |
| collection | DOAJ |
| description | Summary: Background: India's free antiretroviral therapy (ART) programme was initiated in 2004. People living with HIV who were registered with ART centres (ARTC) were initiated on ART based on the CD4 count cutoffs as per prevailing guidelines. The others with higher counts remained on six-monthly follow up. We estimated retention rates among people living with HIV receiving ART in the programme and their determinants during 2012–2017. Methods: In this retrospective cohort study, the records of people living with HIV aged ≥15 years, registered between April 2012 and March 2017 (reference period) in 81 of 396 ARTC across 33 Indian states were reviewed. ‘People living with HIV not on ART’ were defined as all those who were registered but not eligible for ART initiation or not started ART through the reference period. ‘People living with HIV on ART’ were those who were already on ART or initiated on ART as per prevailing guidelines. Relevant data from the clinic records were extracted and analysed for ‘Not on ART’ and ‘On ART’ groups separately using life-table method, Cox proportional hazards model to estimate retention probability and potential determinants. Findings: Of 154,154 registered people living with HIV, 82.3% received ART (‘on ART’) during 2012–2017. Proportion retained was lower among ‘not on ART’ vs ‘on ART’ people living with HIV and was statistically significant (71.1% vs 88.9%, p < 0.001). Five-year retention probability was 57% for ‘not on ART’ and 81% for ‘on-ART’ people living with HIV (p < 0.001). The incidence of cases who were lost to follow up was 12.9 and 4.3/100 person-years among ‘not on ART’ & ‘on ART’ people living with HIV, respectively. Determinants of becoming lost to follow up (Adjusted HR, 95% CI) included ‘being in not on ART’ (Adjusted HR: 2.95, 95% CI: 2.85–3.05) ‘being male’ (1.08, 1.05–1.11); ‘having CD4 count 351–500 cells/mm3’ at registration (1.21, 1.16–1.26); and ‘having tuberculosis’ (1.15, 1.10–1.19). Interpretation: New programmatic strategies for improving retention of people living with HIV in care may benefit by focussing on males, younger ages (15–29 years), CD4 counts during registration, history of or new TB diagnoses and early intervention within the first year. Funding: This study was supported with NOA# SAMS/NACP/IE-ART/NARI/2017/09 dated March 27, 2017, awarded by Strategic Alliance Management Services Pvt. Ltd. (SAMS) with funding support from the Global Fund. |
| format | Article |
| id | doaj-art-b71fb2417f5c4688a1c321fd0734e938 |
| institution | OA Journals |
| issn | 2772-3682 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health - Southeast Asia |
| spelling | doaj-art-b71fb2417f5c4688a1c321fd0734e9382025-08-20T02:01:15ZengElsevierThe Lancet Regional Health - Southeast Asia2772-36822025-03-013410055210.1016/j.lansea.2025.100552Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in contextShweta Chidrawar0Suvarna Sane1Megha Mamulwar2Shilpa Bembalkar3Rachna Thakur4Tarun Bhatnagar5Srikanth P. Tripathy6Shrinivasa B. Marinaik7Damodar Sahu8Subrata Biswas9Shanta Datta10Yogesh Sabde11Rajnarayan Tiwari12Deepak Khismatrao13Bhawani Singh Kushwaha14Anoop Kumar Puri15Chinmoyee Das16Sheela V. Godbole17Sheela GodboleMegha MamulwarSuvarna SaneShilpa BembalkarShweta ChidrawarRachana ThakurDeepak KhismatraoTarun BhatnagarSrikanth P. TripathyP.K. BhavaniB.M. ShrinivasaDamodar SahuS. DuttaSubrata BiswasRajnarayan R. TiwariYogesh SabdeChinmoyee DasBhawani Singh KushwahaAnoop Kumar PuriSamiran PandaSmita KulkarniManisha GhateRadhika BrahmeRajesh YadavAmit NirmalkarShradha GuravD.C.S. ReddyYujwal RajManoj MurhekarK. BoopathiM. Vishnu Vardhana RaoArvind PandeySaritha NairIndrani GuptaAvantika RanjanNaresh GoelR.S. GuptaManish BamrotiyaNeha GargICMR-National Institute of Translational Virology and AIDS Research, Pune, IndiaICMR-National Institute of Translational Virology and AIDS Research, Pune, IndiaICMR-National Institute of Translational Virology and AIDS Research, Pune, IndiaICMR-National Institute of Translational Virology and AIDS Research, Pune, IndiaICMR-National Institute of Translational Virology and AIDS Research, Pune, IndiaICMR-National Institute of Epidemiology, Chennai, IndiaICMR-National Institute of Research in Tuberculosis, Chennai, IndiaICMR-National Institute of Research in Tuberculosis, Chennai, IndiaICMR-National Institute for Research in Digital Health and Data Science, New Delhi, IndiaICMR-National Institute for Research in Bacterial Infections, Kolkata, IndiaICMR-National Institute for Research in Bacterial Infections, Kolkata, IndiaICMR-National Institute for Research in Environmental Health, Bhopal, IndiaICMR-National Institute for Research in Environmental Health, Bhopal, IndiaICMR-National Institute of Translational Virology and AIDS Research, Pune, IndiaNational AIDS Control Organization, New Delhi, IndiaNational AIDS Control Organization, New Delhi, IndiaNational AIDS Control Organization, New Delhi, IndiaICMR-National Institute of Translational Virology and AIDS Research, Pune, India; Corresponding author. ICMR – National Institute of Translational Virology and AIDS Research (ICMR-NITVAR [formerly ICMR-NARI]), Pune, India.Summary: Background: India's free antiretroviral therapy (ART) programme was initiated in 2004. People living with HIV who were registered with ART centres (ARTC) were initiated on ART based on the CD4 count cutoffs as per prevailing guidelines. The others with higher counts remained on six-monthly follow up. We estimated retention rates among people living with HIV receiving ART in the programme and their determinants during 2012–2017. Methods: In this retrospective cohort study, the records of people living with HIV aged ≥15 years, registered between April 2012 and March 2017 (reference period) in 81 of 396 ARTC across 33 Indian states were reviewed. ‘People living with HIV not on ART’ were defined as all those who were registered but not eligible for ART initiation or not started ART through the reference period. ‘People living with HIV on ART’ were those who were already on ART or initiated on ART as per prevailing guidelines. Relevant data from the clinic records were extracted and analysed for ‘Not on ART’ and ‘On ART’ groups separately using life-table method, Cox proportional hazards model to estimate retention probability and potential determinants. Findings: Of 154,154 registered people living with HIV, 82.3% received ART (‘on ART’) during 2012–2017. Proportion retained was lower among ‘not on ART’ vs ‘on ART’ people living with HIV and was statistically significant (71.1% vs 88.9%, p < 0.001). Five-year retention probability was 57% for ‘not on ART’ and 81% for ‘on-ART’ people living with HIV (p < 0.001). The incidence of cases who were lost to follow up was 12.9 and 4.3/100 person-years among ‘not on ART’ & ‘on ART’ people living with HIV, respectively. Determinants of becoming lost to follow up (Adjusted HR, 95% CI) included ‘being in not on ART’ (Adjusted HR: 2.95, 95% CI: 2.85–3.05) ‘being male’ (1.08, 1.05–1.11); ‘having CD4 count 351–500 cells/mm3’ at registration (1.21, 1.16–1.26); and ‘having tuberculosis’ (1.15, 1.10–1.19). Interpretation: New programmatic strategies for improving retention of people living with HIV in care may benefit by focussing on males, younger ages (15–29 years), CD4 counts during registration, history of or new TB diagnoses and early intervention within the first year. Funding: This study was supported with NOA# SAMS/NACP/IE-ART/NARI/2017/09 dated March 27, 2017, awarded by Strategic Alliance Management Services Pvt. Ltd. (SAMS) with funding support from the Global Fund.http://www.sciencedirect.com/science/article/pii/S277236822500023XARTIndiaLost to follow-upNational programmePeople living with HIVPLHIV |
| spellingShingle | Shweta Chidrawar Suvarna Sane Megha Mamulwar Shilpa Bembalkar Rachna Thakur Tarun Bhatnagar Srikanth P. Tripathy Shrinivasa B. Marinaik Damodar Sahu Subrata Biswas Shanta Datta Yogesh Sabde Rajnarayan Tiwari Deepak Khismatrao Bhawani Singh Kushwaha Anoop Kumar Puri Chinmoyee Das Sheela V. Godbole Sheela Godbole Megha Mamulwar Suvarna Sane Shilpa Bembalkar Shweta Chidrawar Rachana Thakur Deepak Khismatrao Tarun Bhatnagar Srikanth P. Tripathy P.K. Bhavani B.M. Shrinivasa Damodar Sahu S. Dutta Subrata Biswas Rajnarayan R. Tiwari Yogesh Sabde Chinmoyee Das Bhawani Singh Kushwaha Anoop Kumar Puri Samiran Panda Smita Kulkarni Manisha Ghate Radhika Brahme Rajesh Yadav Amit Nirmalkar Shradha Gurav D.C.S. Reddy Yujwal Raj Manoj Murhekar K. Boopathi M. Vishnu Vardhana Rao Arvind Pandey Saritha Nair Indrani Gupta Avantika Ranjan Naresh Goel R.S. Gupta Manish Bamrotiya Neha Garg Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context The Lancet Regional Health - Southeast Asia ART India Lost to follow-up National programme People living with HIV PLHIV |
| title | Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context |
| title_full | Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context |
| title_fullStr | Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context |
| title_full_unstemmed | Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context |
| title_short | Effect of antiretroviral therapy on retention of people living with HIV in India (2012–2017): a retrospective, cohort studyResearch in context |
| title_sort | effect of antiretroviral therapy on retention of people living with hiv in india 2012 2017 a retrospective cohort studyresearch in context |
| topic | ART India Lost to follow-up National programme People living with HIV PLHIV |
| url | http://www.sciencedirect.com/science/article/pii/S277236822500023X |
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