Abstract
BackgroundWomen living with HIV are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment. There is little evidence supporting interventions for improving access and treatment adherence among vulnerable groups of women in low- and middle-income countries. The Mobile Phone-BasedApproach forHealthImprovement,Literacy andAdherence (MAHILA) trial is assessing the feasibility, acceptability and preliminary efficacy of a novel, theory-guided mobile health intervention delivered by nurses for enhancing self-care and treatment adherence among HIV-infected women in India.Methods/DesignWomen (n = 120) with HIV infection who screen positive for depressive symptoms and/or other psychosocial vulnerabilities are randomly assigned in equal numbers to one of two treatment arms: treatment as usual plus the mobile phone intervention (experimental group) or treatment as usual (control group). In addition to treatment as usual, the experimental group receives nurse-delivered self-care counselling via mobile phone at fixed intervals over 16 weeks. Outcome measures are collected at baseline and at 4, 12, 24 and 36 weeks post-baseline. Outcomes include antiretroviral treatment adherence, HIV-1 RNA, depressive symptoms, illness perceptions, internalized stigma and quality of life.DiscussionThe MAHILA trial will provide information about how a mobile health counselling intervention delivered by non specialist nurses may improve access to care and support the adherence and clinical outcomes of women with HIV infection living in low- and middle-income countries such as India.Trial registrationNCT02319330 (First received: July 30, 2014; Last verified: January 2016)
Highlights
Women living with human immunodeficiency virus (HIV) are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment
In 2014, 14.9 million people living with the human immunodeficiency virus (HIV) were receiving combination antiretroviral therapy (cART) globally, 13.5 million of whom live in low- and middle-income countries (LMICs) [1]
Our preliminary work indicates that a theory-guided phone intervention originated in the U.S is well suited to the Indian context given the widespread use of mobile phone technology [29]
Summary
Women living with HIV are vulnerable to a variety of psychosocial barriers that limit access and adherence to treatment. While cART has markedly improved the India has seen a 19 % decline in new HIV infections, the country has the third highest number of estimated people living with HIV in the world (~2.1 million) [7, 8], of whom, 39 % are women [9]. This amounts to approximately 0.82 million women, given the large. Depression, a prominent predictor of poor adherence to cART [22,23,24,25,26], is prevalent among women living with HIV in India in whom it is largely under diagnosed and undertreated [27, 28]
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