The Samastha Project in Karnataka, India
A 10-year-old girl and several field workers are sitting in a room in the village of Kurugodu in the southwestern state of Karnataka, India. The girl looks happy and healthy. However, the small green booklet she carries shows that she is a child living with HIV. She is on antiretroviral therapy (ART) and outreach workers from Vimukthi, a nongovernmental organization (NGO) and partner in the Samastha project, have identified adherence problems. Because she accompanied her mother on a trip to a neighboring district and ran out of medication, the girl has missed her ART drugs for a number of weeks. The outreach workers are talking to her and her guardian to help determine the best way to get her back on treatment and avoid missing ART doses in the future.
Her situation is not unusual: adhering to long-term HIV care and ART is challenging for all people living with HIV (PLHIV). It is especially so for PLHIV in rural villages such as those in Kurugodu, which is about three hours away from the nearest HIV care and ART center. Though the number of ART centers in Karnataka has increased dramatically over the past years, such problems as transport and incomplete information remain obstacles to care for PLHIV, and many are lost to follow-up (LFU) after diagnosis. Those who drop out of care will not receive the care or treatment for which they are eligible. And those who are on ART may have adherence problems or may default, rendering them more likely to transmit HIV or become ill.