Cultural Adaptation of a Medication Adherence Intervention for Prisoners in Indonesia

Principal Investigators

Dates: 7/26/2016 - 2/1/2018

Co-Investigators:  Gabriel Culbert, Judith Levy, Frederick Altice, Ann B. Williams, Agung Waluyo

Abstract: The HIV epidemic in Indonesia is expanding and closely intertwined with substance use and incarceration. Very few people living with HIV (<8%) receive treatment with antiretroviral therapy (ART), and HIV-related mortality has increased 427% from 2005-13, despite global reductions. At the core of Indonesia’s HIV epidemic are people who inject drugs, and prisoners for whom ART adherence is problematic, especially after prison release. Successful transition from prison is the most crucial focus for people who inject drugs who interface with prisons. Effective use of ART in prisoners at the point of release could improve health outcomes and limit the spread of HIV.

Set in the context of Indonesia’s large treatment gap, the proposed research project is highly innovative because it will be the first study outside the U.S. to develop and test a medication adherence intervention for released prisoners, who globally are at markedly increased risk of ART non-adherence and mortality. These aims directly address NIDA (FY2016) priority areas for AIDS research including: 1) engaging and retaining substance users in care; and 2) developing evidence-based interventions for challenging, real-world settings. Based on preliminary studies, I have reviewed evidence-based interventions (www.cdc.gov/hiv/prevention/research/compendium/index) applicable to the target population and selected ATHENA, an ART adherence intervention tested in the U.S. and China but never with prisoners. In this project, we will train nurses and peer educators to deliver the ATHENA intervention, and conduct a pilot randomized controlled trial to examine the cultural acceptability and organizational feasibility of the adapted intervention, develop preliminary measures of efficacy, and analyze implementation outcomes.

The results of the proposed pilot study will be used to plan a comparative effectiveness study as part of an R01 or R34 (http://grants.nih.gov/grants/guide/pa-files/PA-15-268.html) submission. Dr. Culbert is uniquely poised to conduct this work because of his strong background in nursing and anthropology, his Indonesian language skills, previous research experience in Indonesian prisons, and productivity in nursing and public health. His co-investigators are experts in HIV prevention and treatment, implementation science, and clinical trials, and include researchers who have previously developed, adapted, and tested medication adherence interventions in high-risk populations in the U.S. and internationally, including people who use drugs and prisoners.

Internal Research Support Program (IRSP)