Evaluation of Provider, Patient and Pharmacy Knowledge, Attitudes and Practices Regarding HIV Care and Use of Antiretroviral Therapy in Pune, India

This study ended in 2007.

Antiretroviral therapy (ART) has dramatically affected morbidity and mortality among HIV-infected persons in industrialized countries. In India, where approximately 4.3 million persons are estimated to be HIV-infected (NACO), the use of ART has been limited because of the high cost of drugs, and the cost and technical complexity of monitoring therapy.  Nonetheless, India has several pharmaceutical companies that are major manufacturers of generic antiretrovirals and efforts are underway to increase affordability, access and use of these antiretrovirals in India.
  
Currently, only those patients who can afford to pay for antiretroviral therapies out of their own finances are being treated. The introduction and use of such antiretrovirals in India present special concerns about how patients are accessing and using these therapies.  Studies in India have suggested that it is not uncommon for individuals to seek advice of pharmacists and medicine shops rather than physicians for the treatment of common ailments.  In addition, it has been observed that having a valid prescription is not necessary to obtain drugs including antibiotics, anti-tuberculosis drugs and psychotropic medications.  Furthermore, patients can access care in a variety of private and public health care settings and therefore HIV care and treatment is likely to be occurring in a myriad of ways.  To date, little data are available in India regarding how patients are accessing HIV care or using antiretroviral therapies, how physicians are managing their HIV-infected patients and their experience using antiretroviral therapies, or how pharmacies are dispensing these therapies. 
 
In the context of HPTN 034, a NIH-funded study of HIV incidence and participant retention in cohorts of HIV serodiscordant couples and high-risk HIV seronegative women in Pune, India, we propose a small study to investigate the knowledge, attitudes, and practices of HIV-infected persons, health care providers, and pharmacists regarding HIV care and use antiretroviral therapies in Pune, India.  This proposed ancillary study will be useful in the recruitment and retention activities of the ongoing HPTN 034 study as well as the forthcoming HPTN 052 study (A randomized trial to evaluate the effectiveness of antiretroviral therapy plus HIV primary care versus HIV primary care alone to prevent the sexual transmission of HIV-1 among discordant couples).   In addition, this study will lead to a better understanding of current HIV treatment knowledge and practices, provide data needed to facilitate the implementation of ART programs in India, and enhance outreach to persons in the Pune community.  

Study Objectives:

1. To describe how health care providers are providing care and treatment of HIV-infected persons with particular emphasis on their experience with antiretroviral therapies.
2. To determine the availability of antiretroviral therapies and how pharmacies are providing these therapies. 
3. To assess the knowledge, attitudes and practices among HIV-infected patients regarding the use of antiretroviral medications and describe how these patients access antiretroviral therapy.