Adapting an effective intervention for enhancing engagement in HIV care to meet the needs of key populations in India

项目概要/摘要 在包括印度在内的许多全球环境中，艾滋病规划署检测和治疗目标的进展缓慢， 据估计，在210万艾滋病毒感染者（PLWH）中，只有46%的人受到病毒抑制。 这一差距在艾滋病毒流行率远高于艾滋病毒感染率的关键人群中尤为明显。 一般人群，但病毒抑制率较低，部分原因是交叉的耻辱。在这 因此，我们寻求适应和试点测试一个全面的健康计划，以解决 男男性行为者参与艾滋病毒连续护理的障碍， 印度的跨性别女性（TGW）。拟议的适应性干预措施以一个概念模型为指导， 整合了我们印度特有的艾滋病污名化模型，该模型表明，污名化可以直接推迟寻求护理， 间接地，与少数民族压力模型改编为印度由我们的印度合作者。内容 涉及到我们早期的Chetana健康坚持干预的适应，发现它成功地 改善印度主流PLWH的依从性和病毒抑制。基于我们最初的 工作，适应包括增加健康组的内容，并将提供一个灵活的格式。它还使用 同行导航员（PN），而不是MA级别的顾问，在双方方便的时候提供量身定制的支持 和地点。我们的印度合作者成功地使用了这种PN模型， 在南非开展研究，将艾滋病毒/艾滋病感染者联系起来，让他们继续接受护理。干预旨在打破 耻辱和寻求照顾，这是特别重要的知识产权，谁必须处理历史上敌对的法律的 环境和严重的隔离，进一步减少了对艾滋病毒预防做法的参与， 服务这一应用还利用了印度采用普遍的测试和治疗政策， 新诊断的KPs立即参与艾滋病毒护理，而不必等到他们满足CD 4 资格标准。我们的印度-美国团队有着悠久的研究合作历史， 多年来在这一背景下与关键人群的合作。因此，我们处于独特的地位，进行拟议的 研究旨在实现以下目标：1）让社区利益攸关方参与适应和试点 测试Chetana-PN健康依从性干预措施，用于印度MSM和TGW， 艾滋病毒感染者和新近或未充分参与护理的人。2a）在小型RCT中评估 和理论指导的适应性干预的可行性，并获得初步的效应量估计 干预措施对男男性行为者和女同性恋者参与护理的影响。2b）定性 Chetana-PN干预中的参与者和导航员经验，并描述 在克服护理障碍方面最成功的是25名接受Chetana-PN干预的参与者 和对等导航器。这些发现随后将用于为未来的RCT提供信息， 这种适应Chetana-PN干预措施对印度性少数群体的有效性。

PROJECT SUMMARY/ ABSTRACT Progress toward UNAIDS testing and treatment targets has been slow in many global settings, including India, where only 46% of the 2.1 million people who live with HIV (PLWH) are estimated to be virally suppressed. This gap is especially pronounced among Key Populations (KP) who have much higher prevalence of HIV than the general population, but lower rates of viral suppression, partly due to intersecting stigma. In this application, we therefore seek to adapt and pilot test a comprehensive wellness program to address the barriers to engagement in the HIV care continuum among men who have sex with men (MSM) and transgender women (TGW) in India. The proposed adapted intervention is guided by a conceptual model that integrates our India-specific HIV stigma model, which showed that stigma can delay care-seeking both directly and indirectly, with the Minority Stress Model adapted for India by our Indian collaborator. The content involves an adaptation of our earlier Chetana wellness adherence intervention which was found to successfully improve adherence and viral suppression among mainstream Indian PLWH. Based on our initial formative work, the adaptation includes added wellness group content and will be offered in a flexible format. It also uses peer navigators (PN), rather than MA-level counselors, to deliver tailored support at mutually convenient times and places. This PN model has been used successfully by our Indian collaborators and in our previous research in South Africa to link and retain PLWH in care. The intervention is intended to break the link between stigma and care seeking, which is especially important for KPs, who must deal with historically hostile legal environments and substantial isolation that further reduces engagement in HIV preventive practices and services. This application also takes advantage of India’s adoption of a universal test-and-treat policy, allowing newly diagnosed KPs to be immediately engaged in HIV care, rather than having to wait until they meet CD4 eligibility criteria. Our Indo-US team has a long history of prior research collaborations as well as more than 20 years of work with key populations in this setting. We are thus uniquely positioned to conduct the proposed research to address the following aims: 1) To engage community stakeholders in the adaptation and pilot testing of the Chetana-PN wellness adherence intervention for use with Indian MSM and TGW who are living with HIV and who are newly or insufficiently engaged in care. 2a) To assess in a small RCT the acceptability and feasibility of the theoretically-guided, adapted intervention and to obtain preliminary effect size estimations for the impact of the intervention on engagement in care, among MSM and TGW. 2b) To characterize participant and navigator experiences in the Chetana-PN intervention and describe the practices that were most successful at overcoming barriers to care with 25 participants who received the Chetana-PN intervention and the peer navigators. These findings will subsequently be used to inform a future RCT designed to establish the efficacy of this adapted Chetana-PN intervention for sexual minorities in India.