# Syndemics and Loss From the HIV Care Continuum in India

> **NIH NIH K23** · BRIGHAM AND WOMEN'S HOSPITAL · 2020 · $195,661

## Abstract

PROJECT SUMMARY
 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.” Our understanding of the causes of loss to HIV care in India, however, is extremely
limited. Common, co-morbid psychosocial and structural conditions—including depression, violence, poverty,
and food insecurity—may be important factors contributing to loss to care in India. Because these conditions
often co-occur and are driven by common structural and social forces, the term “syndemics” has been applied
to refer to the ways in which these conditions interact with each other and mutually reinforce their adverse
impacts on HIV treatment and prevention. Syndemic theory has mainly been applied to explain HIV risk among
men who have sex with men in high-income countries, but few studies have examined the effect of syndemic
conditions on HIV-related health outcomes in low- and middle-income countries such as India. My long-term
career goal is to understand the impact of syndemic conditions on HIV-related outcomes, including loss from
the HIV care continuum, and to develop effective interventions targeting the barriers to care presented by
these syndemic conditions. To achieve this goal, I will need additional mentorship and training in qualitative
methods, complex modeling approaches, and intervention development for the Indian context. Drawing upon
this training and my previous research in this field, I will conduct a study at the YR Gaitonde Centre for AIDS
Research and Education in Chennai, India with the goal of achieving my scientific objective: an understanding
of the impact of syndemic conditions on loss from the HIV care continuum and the development of a pilot
intervention for syndemic-affected PLHIV at risk for loss to care. My central hypothesis is that syndemic
conditions are associated with loss to care and lack of virologic suppression among PLHIV in India. I further
hypothesize that a pilot intervention targeting syndemic-affected PLHIV will be feasible and acceptable to
patients and providers. To test these hypotheses, I will pursue the following 3 specific research aims: 1)
conduct qualitative interviews to refine a model of syndemic conditions contributing to loss to care among
PLHIV in Chennai, India; 2) estimate the impact of syndemic conditions on loss to care and lack of virologic
suppression among PLHIV in India; and 3) develop and pilot-test an intervention to prevent loss to care and
lack of virologic suppression among syndemic-affected Indian PLHIV. I am well positioned to achieve these
aims given my previous research experience with syndemic conditions in LMICs including in India as well as
an internationally renowned mentorship team with expertise in qualitative methods, complex modeling
approaches, syndemic theory, and behavioral interventions. The proposed research is innovative an...

## Key facts

- **NIH application ID:** 9840517
- **Project number:** 5K23MH110338-04
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Brian Tan Chan
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $195,661
- **Award type:** 5
- **Project period:** 2017-01-01 → 2021-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9840517

## Citation

> US National Institutes of Health, RePORTER application 9840517, Syndemics and Loss From the HIV Care Continuum in India (5K23MH110338-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9840517. Licensed CC0.

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