ASHA HIV Health Promotion Intervention in India

描述（由申请人提供）：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疗法的机会正在扩大，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者生活在公共卫生基础设施薄弱的农村地区。在印度，农村妇女受艾滋病毒/艾滋病的影响最严重;她们首当其冲，遭受耻辱，几乎没有自主权或决策权，不识字，很少就业，缺乏艾滋病毒传播的基本知识。这些感染艾滋病毒的妇女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（TB）。据估计，印度有200多万艾滋病毒/结核病合并感染病例; 60%以上的艾滋病患者已发展为结核病。为了满足农村人口的保健需要，印度政府推广了经认可的阿莎保健积极分子，这是一个居住在农村社区的保健倡导者，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WLH边缘化社区的需求，是一项及时和具有社会意义的创新战略。在美国和印度，一个在以社区为基础的定性和纵向艾滋病毒预防和行为改变研究方面拥有丰富经验的研究小组已经准备好为农村WLH设计和试点测试一种新的干预措施，以改善依从性行为，增强他们的心理健康和社会福祉。沿着美国研究人员，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计划进行一项描述性I期研究，然后在II期进行一项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WLH的HIV相关的社会、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/艾滋病高发村招募，那里的ASHA提供一般卫生服务。在四个随机选择的村庄中，有两个村庄将有接受干预战略培训的ASHA。剩下的两个将是常规护理。计划中的项目将在很大程度上由我们的社区合作伙伴设计，这些合作伙伴包括WLH，ASHA和医疗保健专家。我们预计这项为期三年的研究将导致一个文化定制的干预，将导致一个更大的临床试验。

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.