Alcohol and ART Adherence: Assessment, Intervention and Modeling in India

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DESCRIPTION (provided by applicant): India faces a major challenge in providing antiretroviral therapy (ART) services in the next decades to several million people who live with or will acquire HIV/AIDS. At the same time, rising levels of alcohol consumption in HIV vulnerable and infected populations constitutes a formidable barrier to maintaining adherence. This proposed project seeks to: provide a baseline understanding of current ART implementation and alcohol and other challenges to ART adherence; identify and test multilevel interventions that can reduce alcohol consumption as a central factor in enhancing adherence; and develop predictive models for use in India and elsewhere that provides a basis for allocating intervention resources in the most cost-effective way to maximize adherence, reduce years and quality of life lost to HIV, and minimize HIV transmission. The number of people with HIV/AIDS is now estimated to be 2.37 million people. Concomitant with increases in HIV infection, India's alcohol consumption has skyrocketed in the past decade, with high rates of problem drinking in HIV vulnerable populations. The focus of this proposed project is on men who are living with HIV, on ART since alcohol consumption is common among men (21%) but continues to be very low (2%) among women except for special groups such as sex workers It has been well established that a high degree of adherence (> 95%) to Anti-Retroviral Therapy (ART) for HIV/AIDS is necessary to prevent disease progression and transmission. As treatment access increases and patient cohorts mature, managing treatment failure in India will emerge as a central challenge. Interventions have been developed for high income countries to improve adherence. However, these interventions have not been systematically integrated into the HIV prevention or ART framework in middle and low income countries, nor have they been evaluated in terms of their cost-benefit in terms of HIV cases averted and ART adherence improved. In addition, there is no tradition of including alcohol control as a necessary component of the effort to improve ART adherence. The specific aims of this study are thus to: (1) assess the current structure, organization and impact of public ART services with emphasis on alcohol reduction associated with ART adherence; (2) Develop, implement and test multilevel interventions with PLWHAs and communities that can contribute to alcohol reduction, increase ART adherence and prevent disease progression and transmission; and (3) utilize operations research modeling, based on empirical data generated in Aims 1 & 2, to estimate the impact of interventions on reduced HIV infections and the quality and quantity of life for PLWHAs. The proposed project is a trans disciplinary, Indo-US collaboration; the geographic focus of this proposed project will be the major urban centers (Mumbai and Pune) in Maharashtra, the state with India's largest concentration of persons living with HIV/AIDS.