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

项目摘要/摘要 在包括印度在内的许多全球环境中，实现联合国艾滋病规划署检测和治疗目标的进展缓慢， 据估计，在210万艾滋病毒携带者(PLWH)中，只有46%的人被病毒抑制。 这一差距在关键人群(KP)中尤为明显，他们的艾滋病毒感染率远远高于 在一般人群中，但病毒抑制率较低，部分原因是交叉的耻辱。在这 因此，我们寻求调整和试点一项全面的健康计划，以解决 男男性行为者(MSM)和男男性行为者(MSM)参与艾滋病毒连续护理的障碍 印度的变性妇女(TGW)。拟议的适应性干预是由一个概念模型指导的，该模型 整合了我们特定于印度的艾滋病毒污名模型，该模型表明污名可以直接推迟求医 间接地，通过我们的印度合作者改编的适用于印度的少数民族压力模型。内容 涉及到对我们早期的切塔纳健康坚持干预的适应，该干预被发现成功 提高印度主流PLWH的依从性和病毒抑制率。基于我们最初形成的 工作，改编包括增加健康组的内容，并将以灵活的格式提供。它还使用 同行导航员(PN)，而不是MA级别的顾问，在双方方便的时间提供量身定制的支持 和地点。此PN模型已被我们的印度合作者成功使用，并在之前的 在南非进行研究，将PLWH联系起来并将其保留在护理中。这一干预旨在打破 耻辱和寻求关怀，这对KPS特别重要，他们必须处理历史上敌对的法律 环境和大量隔离，进一步减少对艾滋病毒预防做法的参与，并 服务。这一应用程序还利用了印度采用的普遍检测和治疗政策，允许 新诊断的KPS将立即参与艾滋病毒护理，而不是必须等到达到CD4 资格标准。我们的印美团队在之前的研究合作方面有很长的历史，以及20多个 在这一背景下与关键人群合作多年。因此，我们处于独特的地位，可以进行拟议的 旨在解决以下目标的研究：1)让社区利益攸关方参与适应和试点 用于印度MSM和TGW的Chetana-PN健康依从性干预的测试 艾滋病毒携带者以及新近或未充分参与护理的人。2a)在一个小的RCT中评估可接受性 以及理论指导的适应性干预的可行性，并获得初步的效应大小估计 关于干预对男男性接触者和TGW中护理参与度的影响。2b)描述 切塔纳-PN干预的参与者和导航员的经验，并描述了 在克服护理障碍方面最成功，25名参与者接受了切塔纳-PN干预 和同级导航员。这些发现随后将被用来为未来的RCT提供信息，旨在建立 这一改编的切塔纳-PN干预措施对印度的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.