Antiretroviral Therapy under the National Program: Experience of a Single Large Centre in Southern India

Abstract

Introduction: The National Aids Control Organization (NACO) has been providing free Antiretroviral Therapy (ART) in India since 2004. Several concerns exist regarding functional outcome, possible low rates of treatment adherence, treatment failure, mortality and high drug toxicity with the provision of large scale free ART. Aim: This study was done to evaluate the outcomes of ability to return to work, lost to follow up rates, treatment failure and drug toxicity requiring regimen change from the ART centre located in Christian Medical College, Vellore, Tamil Nadu, India, which is a large tertiary care centre attached to an academic Infectious Disease and medical unit in Southern India. Materials and Methods: A prospective longitudinal follow up study on patients enrolled in the NACO ART centre at a large tertiary care hospital in Southern India between April 2008 and April 2012 were followed up for a minimum of two years. Outcomes assessed were WHO clinical stage and functional status at the end of the follow up period, rate of lost to follow up, failure of ART, mortality rate and drug toxicity requiring change of regimen. Results: There were 963 patients included in the study with a mean follow up period of 39.78 months (SD 11.34). At the end of the follow up period, 914 (94.9%) of the patients were asymptomatic (WHO clinical stage 1T) and 92.3% of all patients on treatment were able to return to work after ART initiation. We found low rates of lost to follow up (3.2%), drug toxicity and mortality (5.8%) compared to data from other centres in India. A total of 136 adverse events were recorded, the most common being Zidovudine induced anaemia (7.2%). There was also a very low rate of treatment failure in our cohort. Conclusion: This data shows the overall success of the program and the feasibility of having low rates of lost to follow up because of rigorous methods used in follow up of patients and support offered by attachment to an academic infectious disease unit.

Keywords

• human immunodeficiency
• outcome assessment
• patient
• virus