HIV Prevention and Adherence Intervention for HIV Positives and Partners in India

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DESCRIPTION (provided by applicant): This is a resubmission of "HIV Prevention and Adherence Intervention for HIV Positives and Partners in India" (R01 MH083589). Alcohol abusers in India have high rates of HIV, low access and adherence to antiretroviral therapies (ART), and low rates of condom use. The proposed five-year study is a RCT of network-focused integrated behavioral HIV prevention, HIV medical care, and ART adherence in Chennai, India. The study sample will comprise sexually active PLHAs (n=400), their spouses (n=400), and a family member who provides HIV support (n=400). The PLHAs will be treatment naive patients, have a history of alcohol abuse or dependence, enrolled in the Global Fund program, and initiating ART. Data collection will include sexual risk behaviors, CD4 count, viral load, clinic medical records, ART adherence, social networks and other clinical and psychosocial assessments. Participants will be assessed at baseline, 3-, 6-, 12- and 18- months follow-up. Half of the PLHAs and their spouses and family supporters will be randomly assigned to the culturally tailored 8-session intervention condition, and the other participants to the enhanced standard-of-care control condition. The intervention will include individual, dyad, and family network-focused skills training sessions. Spouses and supporters in both conditions will be offered VCT and free HIV treatment as indicated. The study represents a progression of the decade long collaboration among researchers and clinicians at YRG CARE; Johns Hopkins University (JHU) Bloomberg School of Public Health; and JHU School of Medicine. The study builds on the team's extensive prior social network-oriented HIV intervention research targeting substance users, and expertise on the role of social networks, social support and informal HIV caregiving in HIV prevention and treatment. The study is highly feasible given the Indian government's recent roll-out of free ART, our recent establishment of a community-based HIV treatment and prevention clinic in Chennai, and our prior study findings on the importance of network members for HIV treatment support and prevention. PUBLIC HEALTH RELEVANCE: This proposal has high public relevance due to the low rates of HIV medication adherence found in many impoverished communities domestically and internationally.