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 Table of Contents  
Year : 2018  |  Volume : 20  |  Issue : 1  |  Page : 23-26

Knowledge of anti-retroviral therapy among people living with HIV/AIDS: A cross-sectional study

1 Classified Spl (PSM), DADH, HQ 28 Inf Div, C/O 56 APO, India
2 Department of Community Medicine, AFMC, Pune, Maharashtra, India
3 Dy DGAFMS (P), M Block, Min of Def, New Delhi, India
4 MO (Anaesthesia), Military Hospital Kirkee, India
5 Graded Spl (PSM), DADH, HQ 9 Inf Div, C/O 56 APO, India

Date of Web Publication9-Jul-2018

Correspondence Address:
Lt Col Ravishekar N Hiremath
Classified Spl (PSM) DADH, HQ 28 Inf Div, C/O 56 APO. 908 428
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmms.jmms_54_17

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Background: Anti-retroviral therapy (ART) has substantially improved the survival of people living with HIV-AIDS (PLHAs). The individual and public health responsiveness to ART is, in turn, determined by ART-related knowledge of PLHAs. Objective: To study the knowledge of HIV positive individuals regarding ART and also to study its association with education and duration of HIV positivity. Materials and Methods: This cross-sectional study was conducted at a tertiary level hospital. The study participants were 102 PLHAs who were not yet started on ART and data were collected using a face-to-face interview. Results: The mean age was 35.5 years and 58.8% were educated to 10th standard. About 92.2% were married, and more than 70% belonged to rural areas. Nearly 11.8% felt that there is no treatment available. Surprisingly, 60.8% of the participants had incorrect knowledge about the correct time of initiating ART while 60 (58.8%) participants were aware that ART needs to be taken lifelong. 26.5% said that antiretroviral drugs were associated with side effects. As per predetermined knowledge scores, 79.4% had satisfactory knowledge regarding the treatment. A statistically significant (P = 0.03) relationship was observed between the knowledge scores regarding ART among the study participants and educational status while it was not statistically significant (P = 0.56) as regards duration of HIV positivity. Conclusion: There still exists a considerable gap in knowledge regarding treatment options for HIV/AIDS among the PLHA of this region. Hence, there is a need to increase the awareness regarding the same and implement the same into practice. Periodic counseling is necessary to increase awareness and to clear misconceptions about ART among PLHA.

Keywords: Anti-retroviral treatment, knowledge, people living with HIV/AIDS

How to cite this article:
Hiremath RN, Kunte R, Kotwal A, Ghodke S, Basannar D R, Yadav AK, Basundra S. Knowledge of anti-retroviral therapy among people living with HIV/AIDS: A cross-sectional study. J Mar Med Soc 2018;20:23-6

How to cite this URL:
Hiremath RN, Kunte R, Kotwal A, Ghodke S, Basannar D R, Yadav AK, Basundra S. Knowledge of anti-retroviral therapy among people living with HIV/AIDS: A cross-sectional study. J Mar Med Soc [serial online] 2018 [cited 2023 Feb 1];20:23-6. Available from: https://www.marinemedicalsociety.in/text.asp?2018/20/1/23/236255

  Introduction Top

The burden of HIV in Indian population is varied and is mostly concentrated among the high-risk groups. In 2015, HIV prevalence in adults (15–49 years) in India was 0.26%, with 0.30% among males and 0.22% among females. Among the states, Manipur had the highest estimated adult HIV prevalence of 1.15%. India is moving toward achieving global targets of “zero new infections and zero AIDS-related deaths.” A total number of people living with HIV (PLHIV) in India has been estimated to be 21.17 lakhs where 13.45 lakhs (63.53%) PLHIV require anti-retroviral therapy (ART).[1],[2]

ART has played a significant role in halting and reversing AIDS-related mortality. It has shown considerable improvement in survival chances and quality of life of PLHIV AIDS (PLHAs). India has established 475 ART centers and 987 link ART centers (till March 2015) to cater to PLHAs across all regions.

The major challenges involved in the early initiation and long-term adherence to ART are adverse effects of the drugs, stigma, irregular follow-up consultations, nutritional issues, and lack of awareness.[3],[4] While, on the one hand, early start and inadequate adherence lead to poor concentration of antiretroviral drugs required to contain HIV replication in infected cells. On the other hand, suboptimal awareness and adherence can hasten the development of drug-resistance among PLHAs and lower the ART's role in curbing HIV incidence, transmission, and stabilization. Hence, promoting early start, adequate follow-up and adherence by increasing pre-ART awareness level, plays a vital role for PLHAs.[5],[6]

ART being a lifelong treatment, patient compliance [7] depends on several factors including individual belief, motivation, willingness and awareness about ART at an early phase which needs to be studied within their own socio-cultural context region-wise.[8] Analyzing patient awareness and factors influencing their adherence to ART could help in improving compliance with ART. Studies have classified factors influencing patient compliance into four categories, sociodemographic factors,[9] psychosomatic factors including personal skills, treatment-related aspects (years on treatment regimen, side effects and patient-provider relationship),[10] and socioenvironmental dynamics such as comprehensive treatment management, HIV-related stigma and social sustainability, individual knowledge, and belief of ART during the pre-ART phase.[11],[12]

Adequate knowledge and accurate information about the entire spectrum of HIV infection, ART, and its ultimate outcome are important both for HIV uninfected and HIV-infected persons in particular for bringing a behavioral change, thereby preventing the transmission of infection or preventing the development of advanced disease.[13] There have been many studies focusing on HIV-related knowledge among HIV uninfected persons. However, there is a dearth of literature on the level of knowledge of the HIV infected persons, particularly on ART, which is indeed an indirect predictor of ART adherence when started. Hence, a study on the correlates of HIV-related knowledge, particularly ART will aid the health authorities in giving much needed additional supportive care to these vulnerable groups.[2] This will help in devising appropriate strategies to address specific challenges affecting adherence to ART therapy even before the ART is initiated.

In the backdrop of currently available literature, this study attempts to assess the knowledge regarding antiretroviral treatment among PLHAs, including their misconceptions and to study the association with select variables such as education and the duration of HIV positivity with respect to the knowledge regarding ART.

  Materials and Methods Top

Study setting

The study was a cross-sectional study carried out in a tertiary level hospital located in Maharashtra where the study participants were included based on their willingness to participate, with inclusion criteria being PLHAs who were not yet started on ART.

Sampling method

Since the study was on the universal sample, no sampling was done. All HIV positive individuals who were admitted to the hospital were included in the study as and when they were registered during the study. A total of 102 HIV positive individuals who met the criteria and consented were included in the study. Adequacy of the sample size was, therefore, checked aposteriorly by calculating the minimum sample, keeping the expected parameter (proportion of HIV positive individuals with satisfactory knowledge) at 0.5 and with an acceptable deviation of 0.1 on each side of truth with 95% confidence in an interval estimate. It worked out to be 96 by using the standard formula.

Measurement tools

To estimate the overall knowledge status, each of the questions mentioned was scored with “1' as having the correct knowledge and “0” as having the incorrect knowledge or “no knowledge about that aspect.” In the case of open-ended questions, scores were given corresponding to the number of correct answers. Based on the correct answers, a total score on knowledge about treatment was developed. All the respondents with a score <50% of total scores were grouped as those with unsatisfactory knowledge and those with equal to and above 50% were considered to be having satisfactory knowledge.

Data collection

Data were collected by means of the face-to-face interview by the researcher himself by means of pretested, prevalidated semi-structured questionnaire based on the study objectives. Data were pretested in OPD of a tertiary care hospital, and changes in measurement tools were made. Data obtained was entered into excel sheet and analyzed using statistical software SPSS Statistics for Windows, version x.0 (SPSS Inc., Chicago, Ill., USA). Institutional Ethical clearance was obtained by the institute.

  Results Top

A total of 102 patients were interviewed by the researcher and were categorized as per their respective scores based on knowledge assessment. The mean age of the study patients was 35.5 years (standard deviation = +7.4 years). Most of the participants were in the education category of secondary class (58.8%). About 92.2% were married, 6.9% unmarried and 1% divorced. Nearly 91.2% were Hindus and 8.8% Christians. More than 70% of our participants (n = 73) belonged to rural areas as compared to urban (28.4%, n = 29). As per the state of residence, 49% of participants belonged to one of the six high prevalence states while 50% belonged to other states with 1% from Nepal. More than 40% of our respondents (n = 43, 42.2%) had been detected with HIV in the last 1 year while the majority had been HIV positive for the last one to 5 years (n = 53, 51.9%).

[Table 1] depicts the distribution of the study participants as per their knowledge regarding different aspects of treatment for HIV-AIDS. The participants were interviewed on various attributes of HIV-AIDS and ART. More than 80% of the participants were aware of the availability of appropriate treatment for HIV-AIDS while 11.8% felt that there is no treatment available and 5.9% did not know whether treatment was available or not. Surprisingly, 60.8% of the participants had incorrect knowledge about the correct time of initiating ART although, 31.4% (32) knew correctly that ART was started at CD4 count of ≤350 (as per the WHO 2013 guidelines). Sixty (58.8%) participants were aware of life-long duration for ART. Around one-fourth of the study participants (26.5%) said that antiretroviral drugs were associated with side effects while the same proportion of the participants was unaware about this same issue. As per the laid down methodology and predetermined knowledge scores, using all the studied parameters to assess the level of knowledge regarding treatment, it was observed that majority of the sample population (79.4%) had satisfactory knowledge regarding treatment [Table 2].
Table 1: Distribution of study participants as per knowledge regarding HIV-AIDS and treatment (antiretroviral therapy)

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Table 2: Comparison of participant's knowledge about HIV/AIDS progression, self-care and treatment

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A statistically significant (P = 0.03) relationship was observed between the educational status and knowledge scores regarding treatment among the study participants. Nearly 90% of the participants with intermediate (Class XII)/graduate qualification and 72.6% of participants with Class X and below education had a satisfactory knowledge (Chi-square-uncorrected = 4.51, P = 0.03, df = 1) [Table 3]. 81.4% of the respondents with HIV positivity of more than 2 years had satisfactory knowledge about treatment when compared to 76.7% of respondents with <24 months duration [Table 4]. The relation between duration of HIV positivity and knowledge of self-care was not statistically significant (P = 0.56) suggesting that repeated counseling may not have been done properly.
Table 3: Education status and knowledge about treatment

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Table 4: Duration of HIV positivity and knowledge about treatment

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  Discussion Top

This cross-sectional study was carried out at a tertiary care hospital setting and has brought out many relevant findings. In this study, 82.4% of participants believed that there is treatment available for AIDS and only 31.4% knew correctly what CD4 count, ART should be started. Similar studies in different parts of the world have shown varying results. As per a study carried out in Thailand in 2008, 12% of participants said that there are drugs that can cure HIV/AIDS.[14] In a similar study undertaken in female sex workers by Chaikoolvatana et al. in 2008, 94.9% of participants believed that there are medications that can cure HIV infection.[15] In another study carried out by Dixit et al., 70.2% knew about the importance of CD4 count in initiating treatment [16] while another study carried out in an Indian metropolitan city has shown that 56% of males and 71% of females felt that AIDS can be treated with either allopathic medicines or traditional herbal medicine.[17] A study carried out on college students in South Chennai showed awareness levels regarding treatment aspects to be as low as 40.5%.[18] Similarly, Gupta et al. in their study on PLHAs found that 25.3% believed the disease is curable and only 31.3% believed the disease could be cured by early treatment.[13] Such knowledge about ART and CD4 count is very essential. PLHAs who are not on ART should know what is the cutoff level of the CD4 count and make full efforts to maintain their CD4 count by lifestyle changes and regular monitoring. They should be aware that once ART is started, it will be continued lifelong.

In this study, 58.8% were aware that ART once started should be taken lifelong and only 26.5% believed that ART is associated with significant side effects. In spite of repeated counseling, the awareness level of PLHAs on ART per se was very less. If PLHAs, before starting treatment, are not aware of treatment duration and associated side-effects, then adherence and efficiency may go down. Almeida et al. observed that 43.1% were aware about the lifelong duration of ART and 30% were aware of their adverse effects.[19] Priming PLHAs on ART aspects before starting is very necessary as it may directly affect the progress of the disease because a fully aware PLHAs will take appropriate care and precautions.

As regard to overall knowledge on “Treatment of HIV/AIDS,” 79.4% of the respondents were found to have satisfactory knowledge. This study also revealed statistically significant (P = 0.03) association between education and the level of knowledge regarding treatment among the study participants wherein 90% of intermediate/graduate class participants and 72.6% of participants with education of Class X and below also had satisfactory knowledge scores [Table 3]. Hence, the level of education seems to be an important determinant of knowledge of ART in HIV positive individuals (PLHAs). However, the association between duration of HIV positivity and the level of knowledge regarding treatment among the study participants was not statistically significant (P = 0.56). As per the National AIDS Control Organization Policy, due to continued counseling, the longer a person is HIV positive, the more knowledge about treatment options should increase. In the study, but we found that there was not much difference in knowledge score between the two groups meaning the repeated counseling was not done properly or PLHAs did not show much interest.

The overall mean score for knowledge regarding treatment was 3.52 (out of 6) which is not good. This might be because PLHAs, not in receipt of ART often fall outside the ambit of prevention programs at the national level. Our results also reflect the lacunae in the implementation of the National AIDS Control Policy (IV) at the regional levels, which and warrants more studies to assess the knowledge of PLHAs of ART. This will further ensure the adherence of the latter to ART and hence successful implementation of health programs.

  Conclusion Top

There still exists a considerable gap in knowledge regarding ART treatment and there is a need to raise the awareness regarding the same. The gap in knowledge needs to be improved by directing Information Education Communications (IEC) activities toward HIV positive individuals (PLHAs) pertaining to treatment aspects before they are started on ART so that they are well aware of the facts and figures. Repeated counseling should be carried out while creating awareness to clear misconceptions and doubts, on availability of treatment for HIV (ART) and its role, time of initiation of ART, duration of ART to be taken and side effects associated with ART drugs.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Narrative Country Progress Report of India: Global AIDS Response Progress Reporting 2015. NACO.GOI/NACO/SIM/GR-RPT/200415. India HIV Estimations; 2015. Available from: http://www.unaids.org/sites/default/files/country/documents/IND_narrative_report_2015.pdf. [Last Accessed on 2016 Jun 25].  Back to cited text no. 1
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Bangsberg DR, Moss AR, Deeks SG. Paradoxes of adherence and drug resistance to HIV antiretroviral therapy. J Antimicrob Chemother 2004;53:696-9.  Back to cited text no. 6
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Stone VE, Hogan JW, Schuman P, Rompalo AM, Howard AA, Korkontzelou C, et al. Antiretroviral regimen complexity, self-reported adherence, and HIV patients' understanding of their regimens: Survey of women in the her study. J Acquir Immune Defic Syndr 2001;28:124-31.  Back to cited text no. 9
Schneider J, Kaplan SH, Greenfield S, Li W, Wilson IB. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med 2004;19:1096-103.  Back to cited text no. 10
Simoni JM, Frick PA, Pantalone DW, Turner BJ. Antiretroviral adherence interventions: A review of current literature and ongoing studies. Top HIV Med 2003;11:185-98.  Back to cited text no. 11
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Gupta M, Mahajan VK, Chauahn PS, Mehta KS, Rawat R, Shiny TN, et al. Knowledge, attitude, and perception of disease among persons living with human immunodeficiency virus/acquired immuno deficiency syndrome: A study from a tertiary care center in north India. Indian J Sex Transm Dis 2016;37:173-7.  Back to cited text no. 13
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  [Table 1], [Table 2], [Table 3], [Table 4]

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