Impact of a Rural Village Women (Asha) Intervention on Adherence to Antiretroviral Therapy in Southern India

Abstract

Background Despite the increased prevalence of HIV in the rural female population of India, adherence to antiretroviral therapy continues to be low due to several barriers which discourage rural women. Objectives To assess the effectiveness of an intervention (Asha-Life) delivered by Accredited Social Health Activists to improve antiretroviral therapy adherence of rural women living with AIDS in India compared to that of a usual care group. Method A total of 68 rural women living with AIDS, aged 18–45 years, participated in a prospective, randomized pilot clinical trial and were assessed for several factors affecting adherence, such as sociodemographic characteristics, health history, CD4 cell count, enacted stigma, depressive symptomology, help getting antiretroviral therapy, and perceived therapy benefits. Results Findings at 6 months revealed that, while both groups improved their adherence to antiretroviral therapy, there was greater improvement in the Asha-Life group (p < .001), who reported a greater reduction in barriers to antiretroviral therapy than those in the usual care group. Discussion Antiretroviral therapy adherence showed significant increase in the Asha-Life cohort, in which basic education on HIV/AIDS, counseling on antiretroviral therapy, financial assistance, and better nutrition was provided. The Asha-Life intervention may have great potential in improving antiretroviral therapy adherence and decreasing barriers among rural women living with AIDS in India.

ASHA-Life Intervention Perspectives Voiced by Rural Indian Women Living With AIDS

“…The impact of the program on the physical health of WLA was also reported by the women in terms of CD4 counts and body weight and concur with other research studies (Nyamathi, Hanson, et al, 2012; Nyamathi, Salem, Ernst, Keenan, Suresh, Sinha, Ganguly, Ramakrishnan, & Liu, 2012). …”

“…At six month follow up, the researchers revealed that adherence to ART, CD4 levels, and depressed mood were significantly improved with the AL group as compared to the UC program (p < .001) (Nyamathi, Hanson, et al, 2012; Nyamathi, Salem, Meyer et al, 2012). The AL participants also had significantly greater odds of reducing depressive mood than the UC group (Nyamathi, Salem, Meyer et al, 2012).…”

“…The AL participants also had significantly greater odds of reducing depressive mood than the UC group (Nyamathi, Salem, Meyer et al, 2012). Moreover, the AL WLA significantly improved (p < 0.01) in body mass index (BMI) (Nyamathi, Sinha, et al, 2013).…”

Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review

“…Qualitative studies, reviews or editorials, research published in abstract form only or that did not undergo peer review, studies examining adherence to preor post-exposure prophylaxis or prophylaxis for the prevention of mother-to-child transmission, and any studies that did not report a measure of association between food insecurity or food assistance and adherence were excluded. Methods for the review and inclusion criteria were specified in advance, with the following additional inclusion criteria specified after the full text review: (1) definition of treatment interruption as non-adherence for at least 3 months and exclusion of papers examining treatment interruption as the outcome, (2) exclusion of two papers identified in the search that compared adherence in two groups of wasted HIV patients receiving different types of food supplements [28,29]; and (3) exclusion of studies identified in the search that evaluated combination support programs for PLHIV that included a nutritional component but did not present or permit estimation of the individual effect of food assistance distinct from the other services in the program [30][31][32][33]. Although we did not limit inclusion to adult populations, no studies examined the association between food insecurity and ART adherence in pediatric populations, and only one study examined the association between food assistance and adherence in a pediatric population [34], but was excluded because it did not specify the type of food assistance or the criteria for receiving such support.…”

A Role for Health Communication in the Continuum of HIV Care, Treatment, and Prevention

“…Task shifting, decentralization, and employment of lay health care workers have emerged as promising interventions to address this problem in low- and middle-income settings around the world, including India, Malawi, South Africa and Uganda. 15,41,46–48 …”