abstract: 'Operational research to identify factors predicting poor clinical

  outcomes is critical to maximize patient care and prolong first-line

  regimens for those receiving free antiretroviral therapy (ART) in India.

  We sought to identify social or clinical factors amenable to

  intervention that predict virological outcomes after 12 months of ART.

  We examined a retrospective cohort of consecutive adults initiating free

  nonnucleoside reverse transcriptase inhibitor-based regimens.

  Individuals remaining in care 12 months post-ART initiation were tested

  for HIV viral load and surveyed to identify barriers and facilitators to

  adherence, and to determine clinic travel times and associated costs.

  Uni- and multivariate logistic regression identified factors predicting

  HIV viral load >200 copies/mL after 12 months of ART. Of 230 adults

  initiating ART, 10\% of patients died, 8\% transferred out, 5\% were

  lost to follow-up, and 174/230 (76\%) completed 12 months of ART, the

  questionnaire, and viral load testing. HIV viral load was <200 copies/mL

  in 140/174 (80\%) patients. In multivariate models, being busy with work

  or caring for others (OR 2.9, p < 0.01), having clinic transport times 3

  hours (OR 3.0, p = 0.02), and alcohol use (OR 4.8, p = 0.03) predicted

  viral load >200 copies/mL after 12 months of ART. Clinical outcomes

  following ART are related to programmatic factors such as prolonged

  travel time and individual factors such as being busy with family or

  using alcohol. Simple interventions that alter these factors should be

  evaluated to improve clinical outcomes for populations receiving free

  ART in similar settings.'
affiliation: 'McMahon, JH (Corresponding Author), Alfred Hosp, Infect Dis Unit, Melbourne,
  Vic, Australia.

  McMahon, James H.; Elliott, Julian H.; Lewin, Sharon R., Alfred Hosp, Infect Dis
  Unit, Melbourne, Vic, Australia.

  McMahon, James H.; Wanke, Christine; Jordan, Michael R., Tufts Univ, Sch Med, Dept
  Publ Hlth \& Community Med, Boston, MA 02111 USA.

  Manoharan, Anand; Jose, Hepsibah; Malini, Thabeetha; Kadavanu, Tony; Mathai, Dilip,
  Christian Med Coll \& Hosp, Dept Med, Vellore, Tamil Nadu, India.

  Mammen, Shoba, Christian Med Coll \& Hosp, Dept Clin Virol, Vellore, Tamil Nadu,
  India.

  Elliott, Julian H.; Lewin, Sharon R., Monash Univ, Dept Infect Dis, Melbourne, Vic
  3004, Australia.

  Elliott, Julian H.; Lewin, Sharon R., Burnet Inst, Melbourne, Vic, Australia.'
author: McMahon, James H. and Manoharan, Anand and Wanke, Christine and Mammen, Shoba
  and Jose, Hepsibah and Malini, Thabeetha and Kadavanu, Tony and Jordan, Michael
  R. and Elliott, Julian H. and Lewin, Sharon R. and Mathai, Dilip
author-email: ja.mcmahon@alfred.org.au
author_list:
- family: McMahon
  given: James H.
- family: Manoharan
  given: Anand
- family: Wanke
  given: Christine
- family: Mammen
  given: Shoba
- family: Jose
  given: Hepsibah
- family: Malini
  given: Thabeetha
- family: Kadavanu
  given: Tony
- family: Jordan
  given: Michael R.
- family: Elliott
  given: Julian H.
- family: Lewin
  given: Sharon R.
- family: Mathai
  given: Dilip
da: '2023-09-28'
doi: 10.1080/09540121.2013.845282
eissn: 1360-0451
files: []
issn: 0954-0121
journal: AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV
keywords: 'HIV; intervention targets; antiretroviral therapy; India; virological

  outcomes; adherence'
keywords-plus: 'DRUG-RESISTANCE; MEDICATION ADHERENCE; INCOME COUNTRIES; HIV; CARE;

  CHENNAI; SUPPRESSION; PREDICTORS; RETENTION; CLINICS'
language: English
month: MAY 4
number: '5'
number-of-cited-references: '37'
orcid-numbers: 'McMahon, James/0000-0003-1460-5572

  Lewin, Sharon Ruth/0000-0002-0330-8241'
pages: 559-566
papis_id: 56ece1e0bcabaca29a4120ed101cd65c
ref: Mcmahon2014targetsintervention
researcherid-numbers: 'Lewin, Sharon/Z-3297-2019

  '
times-cited: '2'
title: Targets for intervention to improve virological outcomes for patients receiving
  free antiretroviral therapy in Tamil Nadu, India
type: Article
unique-id: WOS:000331337200006
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '26'
web-of-science-categories: 'Health Policy \& Services; Public, Environmental \& Occupational
  Health;

  Psychology, Multidisciplinary; Respiratory System; Social Sciences,

  Biomedical'
year: '2014'