ASHA HIV Health Promotion Intervention in India

描述(申请人提供)：在印度，估计有570万人感染艾滋病毒；其中250万是妇女。虽然艾滋病患者获得抗逆转录病毒治疗(ART)的机会正在扩大，但大多数治疗中心都位于城市地区。然而，近一半的艾滋病毒感染人口生活在公共卫生基础设施落后的农村地区。在印度，农村妇女受到艾滋病毒/艾滋病的打击最严重；她们首当其冲地遭受耻辱，几乎没有自主权或决策权，文盲，很少就业，缺乏艾滋病毒传播的基本知识。这些艾滋病毒携带者在获得和遵循治疗方案、照顾家庭成员和保持积极的心理健康方面面临着深刻的挑战。使艾滋病毒/艾滋病情况复杂化的是结核分枝杆菌(结核病)。据估计，印度有200多万例艾滋病毒/结核病混合感染病例；超过60%的艾滋病人患上了结核病。为了满足农村人口的健康需求，印度政府促进了AHSA(认可的社会健康活动家)，这是一名居住在农村社区的健康倡导者，在卫生和营养领域促进妇女和儿童的健康。然而，扩大ASHA的作用以满足被边缘化的世界卫生组织社区的需要是一项及时的、具有社会意义的创新战略。一个研究团队在美国和印度的社区定性和纵向艾滋病毒预防以及行为变化研究方面拥有丰富的经验，他们已经准备好设计和试行一种针对农村妇女的新型干预措施，以改善遵守行为，并增强他们的心理健康和社会福祉。来自印度医学研究理事会和全印度医学科学研究所的主要艾滋病毒和结核病研究人员与美国研究人员一起，计划进行描述性第一阶段，然后在第二阶段进行探索性随机临床试验试点研究，以评估由ASHA提供的干预计划的可接受性和有效性，重点是加强结核病和/或艾滋病毒的治疗和护理，促进对疾病的心理适应，以及世界卫生组织的艾滋病毒相关社会、认知、行为、心理和治疗结果。参与者将从印度安得拉邦(AP)农村的四个艾滋病毒/艾滋病高发村庄招募，那里的ASHA提供一般卫生服务。在随机选择的四个村庄中，将有两个村庄接受干预战略方面的培训。剩下的两个将是照常的护理。计划中的计划将主要由我们的社区合作伙伴设计，这些合作伙伴包括世界卫生组织、美国卫生与公众服务部和卫生保健专家。我们预计，这项为期三年的研究将导致一项文化定制的干预措施，这将导致一项更大规模的临床试验。

DESCRIPTION (provided by applicant): In India, an estimated 5.7 million people are infected with HIV; of whom 2.5 million are women. While access to antiretroviral therapy (ART) is expanding for people living with AIDS, most of the treatment centers are located in urban areas. However, nearly half of the HIV infected population live in rural areas plagued with poor public health infrastructure. In India, rural women are the hardest hit by HIV/AIDS; they bear the brunt of stigma, have little autonomy or decision-making power, are illiterate, rarely employed, and lack basic knowledge of HIV transmission. These women living with HIV (WLH) face profound challenges in accessing and following treatment regimens, caring for family members, and maintaining positive mental health. Complicating the HIV/AIDS scenario is Mycobacterium Tuberculosis (TB). It is estimated that there are over 2 million cases of HIV/TB co-infection in India; over 60% of persons with AIDS have developed TB. To address the health needs of the rural population, the Government of India has promoted the ASHA (Accredited Social Health Activist); a health advocate who resides in rural communities and promotes the health of women and children in the areas of hygiene and nutrition. However, the expansion of the ASHAs' role to address the needs of a marginalized community of WLH is an innovative strategy that is timely and of societal relevance. A research team that possesses extensive experience in community-based qualitative and longitudinal HIV prevention and behavioral change research in the US and in India are well poised to design and pilot test a novel intervention for rural WLH to improve adherence behavior and enhance their mental health and social well-being. Along with US researchers, key HIV and TB researchers from the Indian Council for Medical Research and the All India Institute of Medical Sciences plan a descriptive Phase I followed by an exploratory randomized clinical trial pilot study in Phase II, to assess the acceptability and effectiveness of an intervention program, delivered by ASHAs, and focused on enhancing TB and/or HIV treatment and care, and promoting psychological adjustment to illness, and HIV-related social, cognitive, behavioral, psychological and treatment outcomes of WLH. Participants will be recruited from four high prevalent HIV/AIDS villages in rural Andhra Pradesh (AP), India, where ASHAs are providing general health services. Two of the four randomly selected villages will have ASHAs trained in the intervention strategies. The remaining two will be usual care. The planned program will be designed, in significant part, by our community partners composed of WLH, ASHAs, and health care experts. We anticipate this three- year study will lead to a culturally tailored intervention that will lead to a larger clinical trial.