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

描述（由申请人提供）：这是“印度艾滋病毒感染者和合作伙伴的艾滋病毒预防和依从性干预”（R01 MH083589）的重新提交。在印度，酗酒者的艾滋病毒感染率很高，获得和坚持抗逆转录病毒疗法（ART）的机会很少，安全套使用率也很低。拟议的为期五年的研究是一项在印度金奈进行的以网络为重点的综合行为艾滋病毒预防、艾滋病毒医疗保健和抗逆转录病毒治疗依从性的随机对照试验。研究样本将包括性活跃的艾滋病感染者（n=400）、他们的配偶（n=400）和提供艾滋病支持的家庭成员（n=400）。plha将治疗有酒精滥用或依赖史、已参加全球基金项目并开始抗逆转录病毒治疗的初治患者。数据收集将包括性风险行为、CD4细胞计数、病毒载量、诊所医疗记录、抗逆转录病毒治疗依从性、社会网络以及其他临床和社会心理评估。参与者将在基线、3个月、6个月、12个月和18个月的随访中进行评估。一半的艾滋病患者及其配偶和家庭支持者将被随机分配到文化定制的8期干预条件下，而其他参与者将被分配到强化标准护理控制条件下。干预将包括以个人、夫妻和家庭网络为重点的技能培训课程。在这两种情况下的配偶和支持者将提供VCT和免费的艾滋病毒治疗。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的进展；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广泛的先前针对药物使用者的以社会网络为导向的艾滋病毒干预研究，以及关于社会网络，社会支持和非正式艾滋病毒护理在艾滋病毒预防和治疗中的作用的专业知识的基础上。考虑到印度政府最近推出了免费的抗逆转录病毒治疗，我们最近在金奈建立了一个基于社区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，这项研究是高度可行的。公共卫生相关性：由于国内和国际上许多贫困社区的艾滋病毒药物依从率较低，因此该建议具有很高的公共相关性。

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.