Alcohol and ART Adherence: Assessment, Intervention and Modeling (AIM) in India

In India, the prevalence of HIV/AIDS is relatively low, with a reported .25% of the population aged 15-49 living with HIV. However, with the world’s second largest population, this prevalence rate translates into more than two million people living with HIV/AIDS, which makes India the country with the third largest number of people living with HIV/AIDS in the world.

In India, as the HIV prevalence has increased over the past decade, so has the country’s consumption of alcohol. Previous studies have found high rates of problem drinking, such as binge drinking, leads to addictions in HIV-vulnerable populations and have demonstrated that sexually transmitted infections (STIs) and HIV are associated with alcohol use in mobile migrants, and in low-income men who have multiple partners.

India is also currently facing major challenges in providing Anti Retro Viral Therapy (ART) services, a lifeline for those living with HIV, over the next several decades to the several million people who live with or will acquire HIV/AIDS. Compliance with ART medication is key to reduce AIDS-related mortality and ultimately the prevention of the spread of HIV. Adherence to ART treatment is often challenging, however, resulting in resistance to ART medication, which further burdens an already taxed health system.

To address this problem, ICRW will embark on a new, five-year project focused on men living with HIV/AIDS. The project will take place in three phases:

1. Conducting formative research, including interviews with men living with HIV/AIDS, policy-makers and clinicians;
2. Testing individual and community-level interventions on ART adherence for problem drinkers in five ART treatment centers in Mumbai and Thane; and
3. Utilizing operations research modeling, based on empirical data generated in phases one and two, to estimate the impact of interventions on reduced HIV infections and the quality and quantity of life for people living with HIV/AIDS.

The project will provide a baseline understanding of current ART implementation, as well as how alcohol and other challenges may affect ART adherence. The project will also identify and test interventions that can reduce alcohol consumption in order to enhance adherence to ARTs, and will develop a model that will allocate resources in the most cost-effective way to maximize adherence, reduce the amount of years and quality of life lost to HIV/AIDS, and minimize HIV transmission.

The project will focus on Mumbai and Thane, in the Maharashtra state, the two urban centers that currently have the highest concentration of people living with HIV.