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

Nyamathi, Adeline; Hanson, Alecia Y.; Salem, Benissa E.; Sinha, Sanjeev; Ganguly, Kalyan K.; Leake, Barbara; Yadav, Kartik; Marfisee, Mary

doi: 10.1097/NNR.0b013e31825fe3ef

Background: Despite the increased prevalence of HIV in the rural female population of India, adherence to antiretroviral therapy continues to be low because of several barriers that discourage rural women.

Objectives: This study aims to assess the effectiveness of an intervention (Asha-Life) delivered by Accredited Social Health Activists (Asha) to improve antiretroviral therapy adherence of rural women living with AIDS in India compared with that of a usual care group.

Methods: Sixty-eight 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, although 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, support from Ashas, 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.

Adeline Nyamathi, ANP, PhD, FAAN, is Distinguished Professor and Associate Dean for International Research and Scholarly Activities; Alecia Y. Hanson, RN, MSN, is Student; and Benissa E. Salem, RN, MSN, PHN, CNL, is Research Coordinator and Doctoral Student, School of Nursing, University of California at Los Angeles.

Sanjeev Sinha, MD, is Associate Professor, All India Institute of Medical Sciences at New Delhi.

Kalyan K. Ganguly, PhD, is Deputy Director, Indian Council for Medical Research at New Delhi.

Barbara Leake, PhD, is Principal Statistician; and Kartik Yadav, MS, is Research Analyst, School of Nursing, University of California at Los Angeles.

Mary Marfisee, MD, is Medical Director, School of Nursing Health Center at the Union Rescue Mission, University of California at Los Angeles.

Accepted for publication April 11, 2012.

Funding was provided by the National Institute of Mental Health Grant No. MH82662.

The authors have no conflicts of interest to disclose.

Corresponding author: Adeline Nyamathi, ANP, PhD, FAAN, School of Nursing, University of California at Los Angeles, Room 2-250, Factor Building, Los Angeles, CA 90095-1702 (e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.