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Dr. Adey Nyamathi in India

Dr. Adey Nyamathi, has spent a great deal of time doing collaborative research on HIV/AIDS in India. It was nearly a decade ago when she became intrigued by a discussion Indian scientists were having about a new strategy for promoting health in rural villages.

An estimated 2.5 million people are infected with HIV in India, of whom roughly half are women. Access to antiretroviral therapy is expanding for people living with AIDS, but most of the treatment centers are located in urban areas - making the lifesaving therapy difficult to obtain for the nearly half of the HIV-infected population living in rural areas. "The hospital is typically hours away from where they live," explains Nyamathi. Even for those who obtain the therapy, she adds, there is a great need for support to help rural women adhere to the complex medication regimen. What's more, many of these women are illiterate and have little decision-making power; rarely are they employed.

In 2005, as part of its National Rural Health Mission, the Indian government began using ASHAs (Accredited Social Health Activists). The concept involves training lay village women who reside in rural communities to be health advocates who can address the needs of marginalized community members and serve as liaisons to primary care providers - specifically, community nurse midwives, clinic nurses and physicians. At the time, the ASHA effort was focused on reproductive health. But Nyamathi saw potential benefits in training ASHAs in the area of HIV/AIDS. With encouragement from the then-Minister of State, Nyamathi applied for and was funded by the National Institutes of Health to examine the feasibility of such an approach.

The findings from the two phased R34 pilot study offered suggestions as to how lay health providers (Asha) along with nurses and physicians can assist women living with AIDS and provided recommendations for the intervention phase of the study. These included counseling, nutritional support, psychological support, and educational services.  The desire to provide care significantly reduced barriers to adherence.  Findings from the intervention were quite successful in revealing significant improvement in adherence, and in physical and mental health outcomes.

The work conducted in India by Dr Nyamathi and her team has led to an appreciation of the partnership between Asha (lay village women) and nurses in educating and supporting the overall health and nutrition of rural women in India and has led to a recent RO1 focused on promoting the care delivery and nutrition of this vulnerable population of women and children in India. In this photo, Asha are being trained for the upcoming RO1. Government officials approved this study for India as it has high potential for promoting research and practice guidelines in real-world practice.

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