Utilization of Decentralized HIV Clinical Services in Rural Maharashtra, India

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DESCRIPTION (provided by applicant): India has the highest estimated number of HIV cases globally. Sixty percent of its HIV cases occur in rural residents, yet there is currently no system of HIV testing or care services for them. Dr. Gita Sinha's research and career will address the question of how to optimally diagnose and treat rural Indians with HIV. As an Infectious Diseases fellow at Johns Hopkins University, she has conducted a mentored preliminary study identifying low HIV testing utilization and barriers to testing in rural Maharashtra, India, a high-HIV prevalent setting. Using preliminary data and elements of social ecological theory, she has helped design a novel model of "fully-decentralized," or rural clinic-based, HIV testing and care services. With IRSDA support, Dr. Sinha, as a mentored Hopkins faculty member, will conduct a community-based clinical trial in two rural Maharashtra districts, comparing utilization of the fully-decentralized HIV services intervention model with the government's partially-decentralized control model, which offers rural testing and urban-based care. Over the first two years, she will conduct an annual cross-sectional study of community residents and use qualitative interviews to assess changes in and characteristics of utilization of any type of HIV testing in the community. She will calculate utilization rates and conduct an annual clinic-based cross-sectional study to assess changes in and characteristics of specific decentralized HIV testing utilization among clinic attendees. In the third year, she will conduct clinical interviews and data extraction to compare care services utilization and short-term clinical outcomes among rural HIV-diagnosed individuals in each model. Mentored by Dr. Robert Bellinger, a leader in Indo-U.S. collaborative HIV clinical research in India, Dr. Ashok Dyalchand, director of the Institute of Health Management, Pachod (IHMP), an internationally-funded rural health services research organization, and with multi-disciplinary co-advising from Drs.Shruti Mehta, David Peters , Michael Sweat, and Kelly Gebo, Dr. Sinha will also apply School of Public Health courses in Epidemiology, Health Services Research, and Health Behavior directly to her research, and spend significant time in rural India to complete her study. The unique IHMP rural India research environment, outstanding Indo-U.S. institutional collaboration and mentorship, and multi-disciplinary coursework will help Dr. Sinha evolve into an independent investigator studying HIV services and clinical outcomes in rural India.