Project Description: “Examining ART adherence issues in Bangalore, India. This 7-year (2004-2011) NIH-funded study ” (2RO1 MH067513) is a collaboration between St John’s National Academy of Health Sciences (Sara Chandy, MD), the University of California, San Francisco (Principal Investigator Maria Ekstrand, PhD) and YRGCARE, Chennai (N. Kumarasamy, MD), to examine the individual, family, interpersonal, and social forces that influence HIV treatment adherence and HIV drug resistance.

In years 1-3, qualitative and quantitative methods were used to examine these issues among patients receiving HIV treatment in a private clinic setting. Culturally appropriate adherence measures have been developed, including a measure of patient-initiated treatment interruptions. Barriers that interfere with optimal adherence to ART and lead to treatment interruptions have been identified.

In years 4-7 we plan to:
1.Expand our study to a public health clinic setting, to apply, test and modify the adherence model that has been developed for patients attending a private health clinic.

2.Document the relationship between ART adherence and HIV-1 subtype C drug resistance patterns in a cohort of 500 patients recruited from both private and public clinic settings, following them over two years.

3.Develop a culturally-appropriate, theoretically-guided and empirically-based ART adherence intervention and to pilot test and evaluate it first in a private clinic and subsequently in a public clinic setting.