Despite efforts by the National AIDS Control Organisation (NACO) and the Health Ministry, a large percentage of HIV positive people in Karnataka continue to drop out of the Anti Retroviral Therapy (ART) .
Studies show that the attrition is particularly high among patients aged between 15 and 24 years.
While admitting that dropout rates are high, the Karnataka State AIDS Prevention Society (KSAPS) is yet to verify its data on the number of patients it has ‘lost’. Reasons for attrition are plenty, including the need to migrate out of their hometowns in search of jobs and education, Dr Jairaj of KSAPS told Express. Of the 2.8 lakh people who are HIV positive and are registered in ART centres in Karnataka, more than 60 per cent are not receiving treatment.
In 2012-13, of 8.37 lakh people tested for HIV, 25,549 tested positive. Overall, only 74,821 are receiving ART.
Dr Jairaj said efforts were on to trace the remaining patients. The NACO and KSAPS began a HIV Sentinel Surveillance Programme in 1998 but 29,000 registered patients have died since then. Efforts are on to ascertain the cause of these deaths through verbal autopsy, Dr Jairaj added.
“Patients suffering from HIV co-infections like tuberculosis also tend to drop out. They usually have too many tablets to take and often opt out of ART,” he said.
The World Health Organisation revealed in its ‘Global ART Treatment Report 2013,’ that a similar trend existed in sub-Saharan African countries where nearly 40 per cent of people living with HIV dropped out of the programme.
“While nearly half the people tested for HIV drop -out before getting screened for eligibility, 32 per cent disappear between screening and initiation of ART,” the report stated. Dr Glory Alexander, director, Action Service Hope for AIDS Foundation said lack of counselling was the main reason for attrition.
“Before starting patients on ART, it is important to make them understand that they have a lifelong dependence on it,” she said.
Once CD4 count falls below 350, they have to start first line ART even if they feel healthy and have no symptoms, she added. She stressed on a peer adherence support system.
Other reasons for HIV positive patients dropping out of the treatment is the non-availability of medicines in government-run ART centres.
“When registered patients migrate, link workers are supposed to connect them to centres elsewhere. We also lose patients who register fake addresses, and names that can’t be traced,” Dr Glory said.
Dr V Laxmi, professor and head, Department of Microbiology, Nizam Institute of Medical Sciences, Hyderabad, said illiteracy and the resulting lack of awareness was another cause of high dropout rates.