A Behavioral Adherence Intervention Improves Rates of Viral Suppression Among Adherence-Challenged People Living with HIV in South India

  • Maria L. EkstrandEmail author
  • Elsa Heylen
  • Matilda Pereira
  • Jacob D’Souza
  • Shoba Nair
  • Amanda Mazur
  • Ranjani Shamsundar
  • B. N. Ravi Kumar
  • Sara Chandy
Original Paper


The success of antiretroviral therapy (ART) has led to both extended life expectancy and improved quality of life among people living with HIV (PLWH). To maximize the efficacy of first line ART regimens in low- and middle-income countries (LMIC), we need culturally-relevant interventions that empower participants to reduce barriers to long-term uninterrupted adherence. The Chetana adherence intervention trial was designed in collaboration with local community groups as a comprehensive wellness program for adherence-challenged PLWH and included peer-led adherence support, yoga, nutrition, information about local resources, and individual counseling using motivational interviewing techniques. Intervention arm participants were almost twice as likely to be virally suppressed at their 12-month follow-up visit (AOR = 1.98; 95% CI [1.2, 3.23]) as were participants in the active control arm. They were also about twice as likely as control arm participants to self-report ≥ 95% adherence (AOR = 1.86, 95% CI [1.09, 3.15]), and as having eliminated individual adherence barriers (AOR = 2.33, 95% CI [1.51, 3.62]) and clinic attendance barriers (AOR = 2.01, 95% CI [1.20, 3.38]) These low-cost strategies can be implemented by local NGOs, making it both scalable and sustainable in this and similar settings.


HIV ART adherence trial Viral suppression India PLWH LMIC Cultural relevance 



We gratefully acknowledge the staff at the Karnataka ART Centres for referring the study participants as well as the Chetana study staff for their hard work and dedication to the study participants. Finally, we are grateful to the many study participants who so generously shared their time and thoughts with us.

Author Contributions

ME and SC conceived of and designed the study. The first draft of the manuscript was written by ME and EH. All authors commented on previous versions of the manuscript, read and approved the final manuscript.


This study was funded by the National Institutes of Health (R01MH095659).

Compliance with Ethical Standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standard of the Ethics Committees of the University of California, San Francisco and St. John’s Research Institute and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Department of Medicine, Center for AIDS Prevention StudiesUniversity of CaliforniaSan FranciscoUSA
  2. 2.St John’s Research Institute, St John’s National Academy of Health SciencesBangaloreIndia
  3. 3.St John’s Medical College and Hospital, St John’s National Academy of Health SciencesBangaloreIndia
  4. 4.Karnataka State AIDS Prevention SocietyBangaloreIndia

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