Preventing & Treating HIV Comorbidities in India: Multi-tiered Strategy for Women

描述（由申请人提供）：该项目的总体目标是证明，低成本，手机提供的干预措施是一种有前途的，可行的和可接受的方式，以改善印度受艾滋病毒和相互关联的心理健康和心理社会风险因素影响的妇女的预防和治疗结果。在过去十年中，艾滋病毒预防和获得挽救生命的抗逆转录病毒疗法方面有了显著改善。然而，在坚持艾滋病毒护理范围方面的不足对成功构成了重大障碍。妇女处于特别不利的地位。两性不平等、身体和环境因素使许多妇女更容易感染艾滋病毒，心理健康状况不佳，以及相互关联的心理社会辅助因素（抑郁、性别歧视、暴力、缺乏社会支持等）。这些都是艾滋病护理依从性差和保留率低的相关因素。除了PMTCT项目中的短期预防外，很少有坚持性干预措施关注印度妇女。最近的研究表明，这些妇女的失访率高得惊人，特别是在分娩后从预防母婴传播到艾滋病毒终身护理服务的过渡期。为了解决这一差距，美国国家心理健康和神经科学研究所（NIMHANS）和耶鲁大学之间的合作伙伴关系将利用印度和美国临床研究人员，利益相关者和资源的独特合格，多学科团队的互补专业知识。我们的初步工作表明，一个理论指导的坚持电话干预，可以很容易地集成和持续作为常规ART中心服务的一部分，是非常适合的目标人群，但它需要适应社会文化背景。经过初步的形成性工作，以完善在印度交付的interventio，我们将培训诊所护士提供干预，然后在随机试验中评估干预的新应用的可行性，保真度和初步疗效。基线评估后，将女性（n=120）随机分配至常规治疗（TAU）或TAU加电话干预（16周内交付）和结局（例如，抑郁症状、依从性）将在随机化后6、14、24、36周进行评价。如果在本项目中开发和试点测试的有前途的移动的电话干预在本1期研究中显示出我们预期的前景，则将在大规模多中心研究中评估干预的疗效和成本。如果成功，将是一个极其 将采取切实可行的办法，改善印度感染艾滋病毒和患有精神健康问题的妇女的预防和治疗结果。

DESCRIPTION (provided by applicant): The overall objective of this project is to demonstrate that a low cost, cell phone-delivered intervention is a promising, feasible and acceptable way to improve the prevention and treatment outcomes of women in India who are affected by HIV and inter-related mental health and psychosocial risk factors. Over the past decade there have been dramatic improvements in HIV prevention and access to life-saving antiretroviral therapy (ART). Yet, deficits in adherence to the spectrum of HIV care pose significant barriers to success. Women are at a particular disadvantage. Gender inequality, physical and situational factors place many women at increased risk for HIV acquisition and poor mental health and interrelated psychosocial co-factors (depression, gender-discrimination, violence, lack of social support, etc.) that are well established correlates of poor adherence and retention in HIV care. Few adherence interventions have focused on women in India outside of short-term prevention in PMTCT programs. Recent studies have shown alarmingly high rates of loss to follow-up for these women, particularly in the transition after delivery, between PMTCT and lifelong HIV care services. To address this gap, a collaborative partnership between the National Institute of Mental Health and Neuro Sciences (NIMHANS) and Yale University will leverage the complementary expertise of a uniquely well qualified, multidisciplinary team of Indian and U.S. of clinical investigators, stakeholders and resources. Our preliminary work indicates that a theory-guided adherence phone intervention that can be easily integrated and sustained as a component of routine ART Centre services is well suited for the target population, but it needs to be adapted to the sociocultural context. Following initial formative work to refine the interventio for delivery in India, we will train clinic nurses to deliver the intervention, and then evaluate te feasibility, fidelity and preliminary efficacy of the novel application of the intervention in a randomized trial. After baseline assessment, women (n=120) will be randomly assigned to treatment as usual (TAU) or TAU plus the phone intervention (delivered over 16 weeks) and outcomes (e.g., depressive symptoms, adherence) will be evaluated at 6, 14, 24, 36 weeks post-randomization. If the promising mobile phone intervention developed and pilot tested in this project shows promise in this Phase 1 study as we expect, the efficacy and cost of the intervention will then be evaluated in a large scale, multi-site study. If successful, an extremely practical approach will be available to improve the prevention and treatment outcomes of women with HIV and co-morbid mental health problems in India.