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The antiretroviral roll out for HIV in India - strengthening capacity to promote adherence and patient follow-up in the context

Objective

India is a nation of contrasts. The economy is modernizing, but the culture is traditional. Different provinces experience the HIV epidemic differently; even in high-prevalence areas, the epidemic reflects diverse social, cultural, religious, & sexual practices. This proposal focuses on 2 high prevalence provinces. As the antiretroviral (ART) program is scaled up, adherence is a key issue that needs to be addressed (as it is a key determinant of resistance, which has public health consequences). With limited affordable second-line regimens & restricted laboratory monitoring in low-income settings, optimal adherence to first-line regimens is essential. The study is a randomized controlled trial of an approach using a contextually relevant intervention (mobile telephones) to influence ART adherence in 600 ART naïve, HIV+ Indian patients eligible for ART, in Karnataka and Tamil Nadu. The conventional existing approach (as in the national guidelines) will be compared with an intervention in which the patient is provided adherence support using a mobile telephone interface. The study besides assessing the effect of intervention on adherence, will also provide data on the proportion of Indian patients failing first line ART. A study of factors associated with adherence, hitherto unstudied in India will be done. In addition the incidence and manifestations of opportunistic infections, immune reconstitution syndrome & adverse drug events will be described. The use of validated low-cost tests that optimize monitoring, are necessary here. Viral load is rarely used to monitor treatment because it is expensive. Instead falling CD4 counts are used. This usually occurs months/years after virological failure (increasing load); patients could have accumulated enough resistant mutations in this time to render other drugs useless. Using an affordable load test (evaluated in this study) will allow earlier detection of failure in this setting, thus having public health implications. Cost effectiveness will be studied. The project has policy implications for India and other low income settings.

Field of science

  • /medical and health sciences/health sciences/public and environmental health
  • /natural sciences/biological sciences/genetics and heredity/mutation
  • /medical and health sciences/basic medicine/pharmacology and pharmacy/adverse drug reactions

Call for proposal

FP7-HEALTH-2007-B
See other projects for this call

Funding Scheme

CP-SICA - Collaborative project for specific cooperation actions dedicated to international cooperation partner countries (SICA)

Coordinator

KAROLINSKA INSTITUTET
Address
Nobels Vag 5
17177 Stockholm
Sweden
Activity type
Higher or Secondary Education Establishments
EU contribution
€ 880 333
Administrative Contact
Anna-Britta Karlsson (Ms.)

Participants (5)

CBCI Society for Medical Education
India
EU contribution
€ 889 915
Address
St. John's National Academy Of Health Sciences
560034 Bangalore
Activity type
Higher or Secondary Education Establishments
Administrative Contact
Anura Kurpad (Prof.)
Y.R. GAITONDE MEDICAL EDUCATION & RESEARCH FOUNDATION
India
EU contribution
€ 710 073
Address
Rajiv Gandhi Salai, Taramani
600113 Chennai
Activity type
Higher or Secondary Education Establishments
Administrative Contact
Ak Ganesh (Mr.)
Hanoi Medical University
Vietnam
EU contribution
€ 130 003
Address
Ton That Tung- Dong Da 1
10000 Hanoi
Activity type
Higher or Secondary Education Establishments
Administrative Contact
Nguyen Duc Hinh (Prof.)
TAMPEREEN YLIOPISTO
Finland
EU contribution
€ 189 688
Address
Kalevantie 4
33014 Tampere
Activity type
Higher or Secondary Education Establishments
Administrative Contact
Per Ashorn (Prof.)
CAVIDI AB
Sweden
EU contribution
€ 146 408
Address
Dag Hammarsköld Väg 32A
75183 Uppsala
Activity type
Private for-profit entities (excluding Higher or Secondary Education Establishments)
Administrative Contact
Clas Kallander (Dr.)