Utilizing CBPR to Improve Antiretroviral Adherence among Rural Indian Women
Background: CBPR ensures full engagement of communities in the research process. By understanding social and health inequities, researchers can better understand the profound challenges rural WLA face in caring for themselves and their families, and maintaining optimal health. While Asha (lay village women) in India have predominantly focused on reproductive health for mother and infants, investigators have utilized CPPR approaches to train Asha, partnered with healthcare providers, to deliver an intervention designed to improve the medication adherence among rural WLA and enhance their physical and psychological health.
Method: CBPR approaches were infused in the conduct of a randomized clinical trial designed to improve psychological and physical health of 68 rural WLA. Community leaders and WLA living in similar villages guided the research design, assisted with revision and clarity of the questionnaires, and were actively involved in implementing and evaluating the program. Rural WLA were randomized into Asha Life (AL) or usual care (UC) groups. The AL - intervention was delivered over six months and included group sessions, nutritional supplements, life skills and Asha support in maintaining adherence to ART. Inclusion criteria for the WLA were: (a) aged of 18-45; and (b) screened as receiving ART for a minimum of 3 months. Physical health status was obtained by anthropometry (bio-impedance analyzer) and CD4 counts, while depressive symptomology was assessed by structured instruments. ART adherence was measured by monthly pill counts and self-reports for frequency taken. Except for anthropometry and ART monitoring- all other assessments were conducted at baseline and six months.
Findings: At six-month follow-up, findings revealed that adherence was significantly improved ranging from 93% -100% for the AL group (mean 99%; 0.02) and 60% - 95% for the UC group (mean 67%, 0.22). In multivariate analyses, the AL participants also had significantly greater odds of reducing depressive symptoms, improving CD4 levels and weight, BMI, percent fat, fat weight, and lean weight significantly higher in the AL group compared to the UC group.
Implications: The findings of this intervention highlight the benefits of CBPR in addressing the challenges which rural WLA face in overcoming barriers to care and improving psychological and physical outcomes. Likewise, the culturally-relevant AL intervention was significant in impacting the HIV medication adherence.