In India, the estimated number of PLHIV was around 2.4 million in 2021, with Maharashtra being one of the states with the highest burden. The National AIDS Control Organization (NACO) reported a decline in annual new infections by 46.3% from 2010 to 2021, indicating progress in HIV control efforts. ¹

However, challenges persist, particularly in rural areas where healthcare access and ART adherence may be compromised. Antiretroviral therapy (ART) has significantly transformed HIV/AIDS management, enhancing patient survival and reducing transmission rates. Globally, from 2016 to 2021, the number of people living with HIV (PLHIV) remained substantial, with approximately 38 million individuals affected in 2021. During this period, ART coverage expanded, contributing to a decline in AIDS-related deaths.²

In India, the estimated number of people living with HIV (PLHIV) was around 2.4 million in 2021, with Maharashtra being one of the countries with the highest burden. The National AIDS Control Organization (NACO) reported a decline in annual new infections by 46.3 from 2010 to 2021, indicating progress in HIV control efforts. ²

Still, challenges persist, particularly in rural areas where healthcare access and ART adherence may be compromised. Antiretroviral therapy (ART) has significantly transformed HIV/ AIDS management, enhancing patient survival and reducing transmission rates. Globally, from 2016 to 2021, the number of people living with HIV(PLHIV) remained substantial, with approximately 38 million individuals affected in 2021. During this period, ART coverage expanded, contributing to a decline in AIDS-related deaths.³

Despite national-level data, there's a deficit of region-specific studies focusing on the Clinico-epidemiological profiles of patients on ART in rural settings, especially in Maharashtra. Understanding factors like demographic characteristics, treatment adherence, comorbidities, and issues in these populations is crucial for tailoring interventions.

Need of the study: To bridge this knowledge gap by analyzing the clinical and epidemiological aspects of patients receiving ART at a rural medical college's ART center in Maharashtra. The findings will inform targeted strategies to enhance ART program effectiveness and address the unique challenges.

1. Study design: A record-based cross-sectional study.
2. Study setting: The study was conducted in the ART center of Swami Ramanand Teerth Rural Medical College, Ambajogai, district Beed, Maharashtra.
3. Ethical considerations: Ethical committee approval was obtained from the Institutional ethical committee before the start of the study.
4. Study duration: The present study was carried out from February 2022, to December 2022
5. Study population: HIV patients enrolled on ART from 1 January 2016 to June 2021.
6. Inclusion criteria: Complete records of HIV patients & Patients who are Alive on ART
7. Exclusion criteria: Patients with incomplete records, and those who were transferred out, deceased, or lost to follow-up were excluded from the study.
8. 8. Operational definition: adherence to ART. Adherence is determined by dividing the difference between the total pills provided (including leftovers) and the remaining pills by the total number of pills prescribed daily multiplied by the number of days since the last visit to the ART center. The measure thus calculated was multiplied by 100 to express adherence in percentage.³We will classify adherence as optimal (>95%), moderate(80-95%), and poor (<80%).According to the World Health Organization (WHO), viral load suppression is achieved when an individual’s HIV viral load is less than 1000 copies/mL of blood.
9. Sampling technique Sample Size: By convenient sampling technique we have selected ART centre and records in the mentioned timeline. After obtaining clearance from the Institutional Ethics Committee, data from 1208 patients at the ART center was collected, covering the period from January 2016 to June 2021, and was assessed for record completeness & those who are alive were included & Incomplete records, patients who are transferred out, died & lost to follow up were excluded from the study which was 590 while maintaining confidentiality.
10. Conduct of the study:

 Data collection: After submission of the Institutional Ethical Committee approval letter to the ART center, data from the period of 1st January 2016 to 30th June 2021 was obtained. After meeting the inclusion and exclusion criteria 590 patient’s data was analysed.

Data compilation: Collected data were entered into Microsoft Excel 2010 worksheets and coded appropriately.

Data analysis: Data were analyzed using Microsoft Excel 2010, Open EPI-Info Version 3.01 updated on 2013/04/06. Reference Citation⁸:  Vancouver’s system of listing and citing references was used. The references were numbered and listed according to their appearance in the text.

Table no 1 Clinical characteristics of HIV patients on ART.

The study highlights a significant proportion of individuals under 30 years of age (47%) ,(22%)in 30-45 years and above 45 years (31%), suggesting that HIV impacts both younger and older populations. This is consistent with reports that younger populations in rural areas are often at risk due to high mobility and limited access to health education, while older populations may face delayed diagnoses due to stigma or lack of testing facilities⁴ .Around 69 (46.0%) participants are in the 31 – 40 years age group followed by 51 (39.0%) in the 41 – 50 years age group found in the study done by Rajashekar et al in 2023⁵ . A study conducted by Gaidhane S. et al⁶ shows both males and females were equal in number  (112:113) which is comparable to our study that is 51% male and 49% female. 57% of the 200 patients included in this study were female,  and 43% were males.

Educational levels show a predominance of illiteracy (41%), (20%) were educated up to primary education, 23% were up to secondary and 16% were graduated in our study findings.Most of the patients [49 (39.51%)] had completed up to secondary education, followed by primary education [38 (30.65%)], illiterates [31 (25%)], and college and above [6 (4.84%)] was found in Shukla et al study (2015)⁷.The employment data highlights that most individuals are unskilled workers (58%), reflecting the economic challenges faced in rural areas, Most of them were working as laborers/farmers (55%), housewives (14.2%), and drivers (4.8%) which is found in a study done by Jayant D. Deshpande et al ⁸

The marital status data shows a high proportion of married 56%, and widowed individuals (31%) which is lower than found in a study conducted by Rashmi Sharma et al⁹ that is Majority were married (79.8%). Socioeconomic disparities, as evidenced by the high percentage of individuals in Class 4 (55%), which is comparable to the study done by Deshpande et al¹⁰The patients were from the lower middle and lower socio-economic classes.

The predominance of sexual transmission (90%) aligns with national and global trends, reinforcing the importance of targeted sexual health education and behavioral interventions. The low rates of transmission via blood-related products (2%) and parent-to-child transmission (6%) indicate effective screening and prevention programs, though ongoing efforts are needed to address gaps in rural healthcare infrastructure ¹¹.

The distribution of WHO stages, with 56% in Stage 1 and 34% in Stage 2, suggests that early detection and treatment are being achieved for many patients. However, the presence of individuals in advanced stages (10% in Stages 3 and 4) The highest number of patients at the WHO 1-stage was found in the study by Barik et al¹²

The CD4 count data, with 52% of individuals above 500 mm³ and only 15% below 350 mm³, reflects the effectiveness of ART in improving immune function.  A study showed a CD4 count of <250 cells/mm3 in 62.5% of registered cases   in Majumdar et al¹³.

Viral suppression rates (92% with <1000 copies/mL) are commendable and align with studies showing the success of ART centre.¹⁴ The high adherence rate (>95% for 87% of participants) underscores the effectiveness of counseling and support services in ensuring treatment compliance, as supported by studies emphasizing the role of community-based adherence interventions. The high completion rate of INH preventive therapy (99%) reflects well-implemented tuberculosis (TB) prevention programs in ART centers, which is critical given the high risk of TB co-infection in HIV patients⁴

The 92% usage of first-line ART highlights the effectiveness of initial treatment regimens, with a small proportion (8%) requiring second-line therapy, consistent with studies showing similar patterns in rural populations¹⁵ 

The clinico-epidemiological profile offers valuable insights into the demographics, socioeconomic status, and transmission modes among HIV patients. Additionally, the adherence data reflects positive treatment engagement among those on ART, suggesting effective healthcare strategies in place at the rural medical college.

Limitations:
The study relies on secondary data from medical records, which may lack completeness or accuracy. The findings may not generalize to urban settings with different socioeconomic dynamics. Also, data was taken from one ART centre. It provides a snapshot of adherence and outcomes but does not assess longitudinal trends.

Recommendations Address illiteracy and misconceptions about HIV through localized education campaigns. Implement counseling, mobile reminders, and peer support groups to improve adherence among suboptimal adherents. Enhance community-level screening and ensure early initiation of ART to prevent disease progression

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