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

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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.