Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) (www.yrgcare.org) is located in Chennai, the capital of Tamil Nadu state and one of the epicenters of the Indian HIV epidemic. YRG CARE is one of the largest private organizations providing HIV care in India, having treated over 20,000 PLHIV since its founding in 1993. YRG CARE serves patients who are newly diagnosed with HIV as well as experienced patients referred from other HIV providers.
The catchment area of YRG CARE primarily includes Tamil Nadu and Andhra Pradesh states. YRG CARE boasts a well-established research infrastructure as a study site for the HIV Prevention Trials Network and AIDS Clinical Trials Group.
In India, which has the world’s third largest HIV epidemic, loss from the HIV care continuum leads to excess morbidity and mortality among people living with HIV (PLHIV) and jeopardizes the promise of "treatment as prevention.” Common, co-morbid psychosocial and structural conditions—including depression, violence, poverty, and food insecurity—may be important factors contributing to loss from the HIV care continuum in India. Regular assessment of these conditions at clinic visits is difficult because of time constraints, social desirability biases, and patients’ lack of comfort in disclosing sensitive information. Electronic Patient Reported Outcomes (PROs), which consist of patient questionnaires administered directly to patients via tablet or laptop, may allow for the routine, systematic, and accurate capture of important domains such as treatment adherence, depression, and at-risk substance use. PROs may offer the opportunity for intervention at clinical presentation because care providers can be automatically alerted to important issues detected by PROs. There have been successful examples of PROs in non-HIV settings in India as well as in HIV care in high-income countries. However, there have been few examples of PROs in HIV care in low- and middle-income countries, and none in India. To address this gap in knowledge, we will be implementing and evaluating a pilot PROs program at YRG CARE (PI: Dr. Brian Chan). The selected summer students will help with the design and implementation of this pilot program, which will determine the feasibility and acceptability of PROs within the clinical care routine of YRG CARE. Responsibilities will include helping with the adaptation of existing YRG CARE psychosocial and adherence questionnaires into a PROs format; construction, testing, and trouble-shooting of the ePROs system including incorporation of Audio Computer-Assisted Self-Interview (ACASI) software for patients who are illiterate; and assessments of the feasibility and acceptability of PROs among patients and staff members.
Time permitting, students will also assist with patient follow-up activities related to Dr. Chan’s ongoing National Institute of Mental Health-funded project on structural and psychosocial barriers to HIV care in India. Students will also have the opportunity to conduct analyses using the YRG CARE Natural History database, which includes data on patient demographics as well as clinical and laboratory data. Students will shadow Dr. Chan and/or YRG CARE HIV clinicians during rounds and clinic sessions and may also wish to get involved in related projects such a women’s livelihood project, community outreach initiatives, and children’s camps. Depending on interest and availability, the student(s) will also have an opportunity after the internship period is completed to analyze data and write abstracts and manuscripts under Dr. Chan’s direction.
Duties and Responsibilities:
Help with the development and roll-out of a pilot PROs program at YRG CARE
Assist in patient follow-up activities for ongoing project on structural and psychosocial barriers to HIV care
Shadow HIV clinicians and potentially participate in community programs allied with YRG CARE
Experience & Qualifications:
Prior experience living/working in a low/middle-income country and interest in the intersection of medical informatics, global health, and HIV would be helpful, but are not strictly necessary
India is a colorful and interesting place to work, but can be chaotic, unpredictable, and occasionally frustrating. Thus, open-mindedness and flexibility, in addition to eagerness, humility, and ability to be culturally sensitive, are necessary qualifications.
YRG CARE has guest housing for a nominal cost.
Brief descriptions from the Summer 2017 Fellows:
“This summer I am interning at YRG Centre for AIDS Research and Education in Chennai, India. I am working on a study that aims to better understand the psychosocial and structural factors that impact loss from the HIV care continuum in India. I also spend time shadowing the clinicians and counselors to gain insight into the many aspects of care for people living with HIV.” – Isabella Colocci
“Along with an incredible team of Indian and American coworkers, I am spending this summer at the Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) researching how and why people living with HIV either adhere or stop adhering to their treatment regimens. Our research, which will include interviews with over 60 patients, will add to the vast body of research produced at YRGCARE that has helped lead the fight against the HIV/AIDS epidemic in India and beyond. I am also lucky enough to be involved in YRGCARE's mission to empower the wider HIV/AIDS community by participating in children's camps and community cooking programs for underprivileged community members.” – Jared Perlo