Academic journal article Bulletin of the World Health Organization

Outcomes of Antiretroviral Therapy in a Northern Indian Urban clinic/Resultats Du Traitement Antiretroviral Dans Un Dispensaire Urbain Du Nord De l'Inde/Resultados De la Terapia Antirretroviral En Un Dispensario Urbano En El Norte De la India

Academic journal article Bulletin of the World Health Organization

Outcomes of Antiretroviral Therapy in a Northern Indian Urban clinic/Resultats Du Traitement Antiretroviral Dans Un Dispensaire Urbain Du Nord De l'Inde/Resultados De la Terapia Antirretroviral En Un Dispensario Urbano En El Norte De la India

Article excerpt

Introduction

The number of people infected with the human immunodeficiency virus (HIV) worldwide was estimated to be 33.2 million at the end of 2007. (1) The introduction of antiretroviral therapy (ART) has significantly reduced morbidity and mortality in HIV-infected patients in various developed and developing countries. (2-5) However, the outcome of ART in India's national ART programme has not been reported.

Background

India is a developing nation with approximately 2.4 million people living with HIV and a national prevalence of HIV infection in adults of 0.36%. (1) Until 2004, ART was available only to a select subset of patients through the private sector; most of the HIV-infected population was unable to afford ART. India's national ART programme was launched on 1 April 2004 under the National AIDS Control Organisation (NACO), as an initiative of the Ministry of Health and Family Welfare of the Government of India. The programme was launched in eight institutions in six states with a high prevalence Of HIV infection, and in the National Capital Region of Delhi. By December 2008, 197 ART centres were functioning in 31 states and union territories and more than 193 000 patients were accessing free ART through these centres. (6)

Setting

To ascertain the functioning and efficacy of the national ART programme, we assessed an ART centre that was opened at the All India Institute of Medical Sciences (AIIMS) Hospital, New Delhi, in May 2005.

The AIIMS Hospital provides tertiary care to the population of Delhi and its neighbouring states, and most of its patients come from the lower socioeconomic strata. Patients with HIV infection tend to present in advanced stages of acquired immunodeficiency syndrome (AIDS) and are usually referred to the hospital's ART centre, which is staffed by a nodal officer, two physicians, a laboratory technician, a pharmacist, a nurse (who also acts as an AIDS educator), an ART counsellor, a data manager and a community health worker. The centre receives financial and logistic support from NACO through the Delhi State AIDS Control Society.

This paper reports the outcomes of ART delivered from the clinic at the AIIMS Hospital and highlights some of the problems encountered in implementing ART.

Methods

To evaluate the effectiveness of the national ART programme at the AIIMS Hospital, we undertook a prospective observational study involving ART-naive patients who were started on ART between May 2005 and October 2006. ART was offered to these patients in accordance with NACO guidelines. (7) The regimen consisted of two nucleoside reverse transcriptase inhibitors and one non-nucleoside reverse transcriptase inhibitor. The available drugs included efavirenz, lamivudine, nevirapine and zidovudine. The medications were dispensed directly to the patients or their authorized representatives.

Patients were seen 2 weeks after the start of ART and thereafter on a monthly basis. During each visit, patients were evaluated for drug toxicity, clinical improvement and opportunistic infections. Adherence was assessed during each visit by pill count, and, through counselling, patients were motivated to adhere to therapy. Patients who failed to turn up within a week of the scheduled visit were contacted by telephone. The CD4+ lymphocyte (CD4) count (cells/[micro]l) was estimated at baseline and at 6-month intervals during follow-up. Prophylaxis and treatment of opportunistic infections were in accordance with NACO guidelines. Anti-tuberculosis treatment was administered according to the Revised National Tuberculosis Control Programme guidelines. (8)

Results

Between 1 May 2005 and 31 October 2006, 1325 patients were enrolled in the ART clinic. Of these patients, 631 treatment-naive adolescents and adults were eligible for the study. Baseline characteristics for those enrolled in the study are provided in Table 1. …

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