Access, adherence, quality and impact of ARV provision to current and ex-injecting drug users in Manipur (India): an initial assessment.

OBJECTIVES: This study aims to understand who is obtaining anti-retroviral therapy (ART) in Manipur, and to determine adherence, access, and impact amongst those who use it. It also explores the quality of these services, their impact and the level of user satisfaction.

METHODS: A mixed method approach was used for this assessment involving direct observations, analysis of service statistics, and a semi-structured survey (n=226).

RESULTS: Less than 5% of current injecting drug users (IDUs) were accessing ART (despite IDUs making up the single largest category affected by HIV in Manipur). Self-reported treatment adherence amongst patients is poor. Major factors influencing adherence are current alcohol use, the cost of ART, having attending any counselling in the last 6 months, income levels of below Indian Rupees (INR) 2000 and negative experience of side effects. Client satisfaction is associated with: duration of time spent with doctors, waiting time and how staff treat the patients. Service quality also requires improvement. A quarter of patients on ART perceive that it has benefited their health and report feeling well. Side effects were experienced by 61% of those on ART. Greater efforts to bring more active IDUs into treatment, whilst improving the manner in which ART is delivered in Manipur are required.