The proposed study is a competing continuation of 1R01MH067513, designed to enhance our ongoing research program on antiretroviral adherence in India. In the first two and a half years of the current study, we have identified culturally-specific adherence patterns and barriers, developed feasible and acceptable adherence measures, and developed reliable and valid scales to examine AIDS-related stigma. We recruited a cohort of private clinic patients on ART, have excellent retention rates (96% at both 6 and 9 months), and developed a working model of ART adherence in this setting. In this proposal, we will continue to build on this work by developing and pilot testing an adherence intervention for private clinic patients. We also propose to address two important new questions that have arisen with the evolution of HIV treatment in India and that may have implications for adherence interventions and treatment guidelines. When this study was first proposed, ART was available on a limited basis in India, and only in the private sector. In 2004, the Indian government began distributing ART, and currently treats about 2/3 of the approximately 70,000 Indian ART patients. Preliminary data suggest that some factors that impact adherence may operate somewhat differently in the public sector. We therefore propose to extend our research to a public clinic setting, to examine the applicability of our working model of adherence and to use these data to modify and pilot test our private clinic intervention in the public health sector as well. Given that only a limited number of first-line ART regimens are available at free or greatly reduced rates in India, as in much of the developing world, prevention of the development of HIV drug resistance is critical to maximizing the efficacy and durability of these regimens and to prevent the transmission of drug resistant virus. However, the longitudinal data needed to accomplish this goal are lacking in the Indian setting, and resistance data only exists on a total of 53 treatment-experienced patients to date. Longitudinal studies examining the development of HIV drug resistance in India are therefore urgently needed and may also have implications for treatment guidelines for other countries affected with HIV subtype C. The current grant has placed our research team in a position to address these critical issues. We have Indian government clearance for our research, an excellent research infrastructure, access to patients in both private and public clinics, and have assembled a team of experts in the fields of adherence, HIV treatment and resistance. We are thus uniquely positioned to quickly implement the first Indian study of the association between adherence patterns, types of regimens and the development of HIV drug resistance and to pilot test the first empirically-based ART adherence intervention in India.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH067513-07
Application #
7846746
Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
Program Officer
Stirratt, Michael J
Project Start
2003-04-09
Project End
2012-05-31
Budget Start
2010-06-01
Budget End
2012-05-31
Support Year
7
Fiscal Year
2010
Total Cost
$428,617
Indirect Cost
Name
University of California San Francisco
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Ekstrand, Maria L; Heylen, Elsa; Mehta, Kayur et al. (2018) Disclosure of HIV Status to Infected Children in South India: Perspectives of Caregivers. J Trop Pediatr 64:342-347
Mehta, Kayur; Ekstrand, Maria L; Heylen, Elsa et al. (2016) Perspectives on disclosure among children living with HIV in India. Child Youth Serv Rev 71:277-281
Sara, Chandy; Elsa, Heylen; Baijayanti, Mishra et al. (2016) Clinical Correlates and Drug Resistance in HIV-Infected and -Uninfected Pulmonary Tuberculosis Patients in South India. World J AIDS 6:87-100
Mehta, K; Ekstrand, M L; Heylen, E et al. (2016) Adherence to Antiretroviral Therapy Among Children Living with HIV in South India. AIDS Behav 20:1076-83
Garrido-Hernansaiz, Helena; Heylen, Elsa; Bharat, Shalini et al. (2016) Stigmas, symptom severity and perceived social support predict quality of life for PLHIV in urban Indian context. Health Qual Life Outcomes 14:152
Heylen, Elsa; Panicker, Siju Thomas; Chandy, Sara et al. (2015) Food Insecurity and Its Relation to Psychological Well-Being Among South Indian People Living with HIV. AIDS Behav 19:1548-58
Neogi, Ujjwal; Rao, Shwetha D; Bontell, Irene et al. (2014) Novel tetra-peptide insertion in Gag-p6 ALIX-binding motif in HIV-1 subtype C associated with protease inhibitor failure in Indian patients. AIDS 28:2319-22
Lang, Tess; Heylen, Elsa; Perumpil, Sheeja et al. (2014) Quality of life and psychosocial well-being among children living with HIV at a care home in Southern India. Vulnerable Child Youth Stud 9:345-352
Neogi, Ujjwal; Shet, Anita; Sahoo, Pravat Nalini et al. (2013) Human APOBEC3G-mediated hypermutation is associated with antiretroviral therapy failure in HIV-1 subtype C-infected individuals. J Int AIDS Soc 16:18472
Neogi, Ujjwal; Heylen, Elsa; Shet, Anita et al. (2013) Long-term efficacy of first line antiretroviral therapy in Indian HIV-1 infected patients: a longitudinal cohort study. PLoS One 8:e55421

Showing the most recent 10 out of 19 publications