Adherence to antiretroviral therapy.

INTRODUCTION: The goal of HAART is to achieve maximal and durable suppression of virus replication. Adherence plays a very important role in success of antiretroviral therapy. AIMS AND OBJECTIVES: To find out the rate of adherence and factors that influence adherence to antiretroviral therapy (ART). MATERIAL AND METHODS: The present study was conducted in the Department of Medicine in a tertiary care hospital from November 2007 to September 2009. Patients attending ART centre OPD and started on ART for at least 6 months were included in the study. A pretested proforma and MMAS adherence questionnaire of every patient was used for data collection. Univariate and multivariate logistic regression analysis was done to identify factors associated with adherence. OBSERVATIONS AND RESULTS: A total of 300 patients attending ART OPD and satisfying inclusion criteria were studied. Adherence rate of >95% was reported by 290 (97%) patients. On MMAS scale 78% of the patients were found adherent to the treatment. On multivariate analysis factors such as age, addictions, difficulty in remembering treatment, finding treatment to be difficult, taking traditional medicines and having no one to remind about medicines were found to be associated with nonadherence. The most common reason for nonadherence were missing pills while travelling or being out of home. CONCLUSIONS: Adherence to antiretroviral treatment in the ART centre is high. During counseling sessions giving up addictions, avoiding traditional medicines, addressing the apprehensions about treatment, and identifying reminder systems should be emphasized. The patients should be advised to carry medications while traveling and when away from home.

Changing Scenario in Indian Contraceptive Methods: A Glimpse Through a Tertiary Hospital Statistics.

BACKGROUND: The patient scenario of a tertiary hospital changes with the implementation of various national programmes in any country. These programmes are conceived after understanding the felt need of the society. Though IUCD was available as an interval method of contraception in the past also and was meant to be effective for 10 years, the prerequisite to come again to the medical facility after 6 weeks of childbirth for insertion resulted in almost all patients to dropout and only the highly motivated would come on their own. Post-partum insertion of IUCD at the time of childbirth or within 48 h has addressed the need of contraception in the post-partum period as well as omitted the need for second visit to a health set-up. Earlier, after achieving the desired family goal of children, tubectomy was the preferred choice, irrespective of age of children but PPIUCD seems to have come up as a long-term reversible method of contraception. OBJECTIVE: The present study was conceived to study the shift of method of long-term contraception from tubal sterilization and vasectomy to PPIUCD over a period of 8 years from 2010 to 2017. METHOD: This study was a retrospective analytical study conducted at the Department of Obstetrics and Gynaecology in Safdarjung Hospital between the years 2010 and 2017. The number of IUCDs inserted post-placental (i.e. within 10 min of delivery of placenta) and within 48 h (of vaginal childbirth) and intra-caesarean (intrauterine insertion while performing caesarean) were recorded and analysed. Also, sterilizations (tubectomy) and interval IUCD insertions done during this time period were compared. RESULTS: With the introduction of PPIUCD in national family programme, more women are inclining towards long-term spacing method and not resorting to sterilizations. PPIUCD is preferred over interval IUCD. CONCLUSIONS: PPIUCD is there to stay as a method of long-term contraception.