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.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Planning Grant (R34)
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Special Emphasis Panel (ZMH1-ERB-H (11))
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Pequegnat, Willo
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University of California Los Angeles
Schools of Nursing
Los Angeles
United States
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Nyamathi, Adeline; Sinha, Sanjeev; Ganguly, Kalyan K et al. (2013) Impact of protein supplementation and care and support on body composition and CD4 count among HIV-infected women living in rural India: results from a randomized pilot clinical trial. AIDS Behav 17:2011-21
Nyamathi, Adeline; Heravian, Anisa; Salem, Benissa et al. (2013) Physical and mental health of rural southern Indian women living with AIDS. J Int Assoc Provid AIDS Care 12:391-6
Nyamathi, Adeline; Ekstrand, Maria; Zolt-Gilburne, Jessica et al. (2013) Correlates of stigma among rural Indian women living with HIV/AIDS. AIDS Behav 17:329-39
Nyamathi, Adeline; Ekstrand, Maria; Salem, Benissa E et al. (2013) Impact of Asha intervention on stigma among rural Indian women with AIDS. West J Nurs Res 35:867-83
Nyamathi, Adeline; Hanson, Alecia Y; Salem, Benissa E et al. (2012) Impact of a rural village women (Asha) intervention on adherence to antiretroviral therapy in southern India. Nurs Res 61:353-62
Nyamathi, Adeline; Salem, Benissa E; Meyer, Visha et al. (2012) Impact of an Asha intervention on depressive symptoms among rural women living with AIDS in India: comparison of the Asha-Life and Usual Care program. AIDS Educ Prev 24:280-93
Nyamathi, Adeline; Salem, Benissa; Ernst, E J et al. (2012) Correlates of Adherence among Rural Indian Women Living with HIV/AIDS. J HIV AIDS Soc Serv 11:327-345
Nyamathi, Adeline; Heravian, Anisa; Zolt-Gilburne, Jessica et al. (2011) Correlates of depression among rural women living with AIDS in Southern India. Issues Ment Health Nurs 32:385-91
Nyamathi, Adeline M; Sinha, Sanjeev; Ganguly, Kalyan K et al. (2011) Challenges experienced by rural women in India living with AIDS and implications for the delivery of HIV/AIDS care. Health Care Women Int 32:300-13
Nyamathi, Adeline M; William, Ravi Raj; Ganguly, Kalyan K et al. (2010) Perceptions of Women Living with AIDS in Rural India Related to the Engagement of HIV-Trained Accredited Social Health Activists for Care and Support. J HIV AIDS Soc Serv 9:385-404