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

描述（由申请人提供）：这是“印度HIV阳性者及其伴侣的HIV预防和依从性干预”（R 01 MH 083589）的重新提交。在印度，酗酒者感染艾滋病毒的比率很高，抗逆转录病毒疗法的获得和坚持率很低，避孕套的使用率也很低。这项为期五年的研究是一项在印度钦奈进行的以网络为中心的综合行为艾滋病毒预防、艾滋病毒医疗保健和ART依从性的RCT。研究样本将包括性活跃的艾滋病毒携带者（n=400），他们的配偶（n=400），和一个家庭成员谁提供艾滋病毒的支持（n=400）。这些艾滋病病毒携带者将是未经治疗的患者，有酒精滥用或依赖史，参加了全球基金项目，并开始接受抗逆转录病毒治疗。数据收集将包括性风险行为、CD 4计数、病毒载量、诊所医疗记录、抗逆转录病毒治疗依从性、社交网络和其他临床和心理社会评估。将在基线、3个月、6个月、12个月和18个月随访时对受试者进行评估。一半的艾滋病毒携带者及其配偶和家庭支持者将被随机分配到文化定制的8次干预条件，其他参与者将被分配到增强的护理标准控制条件。干预措施将包括以个人、二元和家庭网络为重点的技能培训课程。这两种情况下的配偶和赡养者将获得自愿咨询和检测以及所述的免费艾滋病毒治疗。这项研究代表了YRG CARE的研究人员和临床医生之间长达十年的合作进展;约翰霍普金斯大学（JHU）彭博公共卫生学院;和JHU医学院。该研究建立在该团队之前针对药物使用者的广泛的以社交网络为导向的艾滋病毒干预研究以及关于社交网络，社会支持和非正式艾滋病毒预防和治疗中的作用的专业知识的基础上。鉴于印度政府最近推出免费ART，我们最近在钦奈建立了一个以社区为基础的艾滋病毒治疗和预防诊所，以及我们之前关于网络成员对艾滋病毒治疗支持和预防的重要性的研究结果，这项研究是非常可行的。公共卫生相关性：由于在国内和国际上许多贫困社区中发现的艾滋病毒药物依从性很低，因此该建议具有很高的公众相关性。

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.