Suchergebnisse

Abstract Background Food insecurity and poor nutrition are key barriers to anti-retroviral therapy (ART) adherence. Culturally-appropriate and sustainable interventions that provide nutrition counseling for people on ART and of diverse nutritional statuses are needed, particularly given rising rates of overweight and obesity among people living with HIV (PLHIV). Methods As part of scale-up of a nutritional counseling intervention, we recruited and trained 17 peer counselors from 14 government-run HIV clinics in Honduras to deliver nutritional counseling to ART patients using a highly interactive curriculum that was developed after extensive formative research on locally available foods and dietary patterns among PLHIV. All participants received the intervention; at baseline and 2 month follow-up, assessments included: 1) interviewer-administered, in-person surveys to collect data on household food insecurity (15-item scale), nutritional knowledge (13-item scale), dietary intake and diversity (number of meals and type and number of food groups consumed in past 24 h); and 2) anthropometric measures (body mass index or BMI, mid-upper arm and waist circumferences). We used multivariable linear regression analysis to examine changes pre-post in food insecurity and the various nutritional outcomes while controlling for baseline characteristics and clinic-level clustering. Results Of 482 participants at baseline, we had complete follow-up data on 356 (74 %), of which 62 % were women, median age was 39, 34 % reported having paid work, 52 % had completed primary school, and 34 % were overweight or obese. In multivariate analyses adjusting for gender, age, household size, work status, and education, we found that between baseline and follow-up, household food insecurity decreased significantly among all participants (β = −0.47, p < .05) and among those with children under 18 (β = −1.16, p < .01), while nutritional knowledge and dietary intake and diversity also significantly improved, (β = 0.88, p < .001; β = 0.30, p < .001; and β = 0.15, p < .001, respectively). Nutritional status (BMI, mid-arm and waist circumferences) showed no significant changes, but the brief follow-up period may not have been sufficient to detect changes. Conclusions A peer-delivered nutritional .

Optimal strategies to improve food security and nutrition for people with HIV (PLHIV) may differ in settings where overweight and obesity are prevalent and cardiovascular disease risk is a concern. However, no studies among PLHIV have investigated the impact of food support on nutritional outcomes in these settings. We therefore assessed the effect of food support on food insecurity and body weight in a population of PLHIV with high prevalence of overweight and obesity. We implemented a pilot intervention trial in 4 government-run HIV clinics in Honduras. The trial tested the effect of a monthly household food ration plus nutrition education (n=203), compared to nutrition education alone (n=197), over 12 months. Participants were clinic patients receiving antiretroviral therapy (ART). Assessments were obtained at baseline, 6 and 12 months. Primary outcomes for this analysis were food security, using the validated Latin American and Caribbean Food Security Scale, and body weight (kg). Thirty-one percent of participants were overweight (22%) or obese (8%) at baseline. At 6 months, the probability of severe food insecurity decreased by 48.3% (p < 0.01) in the food support group, compared to 11.6% in the education-only group (p<0.01). Among overweight or obese participants, food support led to average weight gain of 1.13 kg (p<0.01), while nutrition education alone was associated with average weight loss of 0.72 kg (p<0.10). Nutrition education alone was associated with weight gain among underweight and normal weight participants. Household food support may improve food security but not necessarily nutritional status of ART recipients above and beyond nutrition education. Improving nutritional tailoring of food support and testing the impact of nutrition education should be prioritized for PLHIV in Latin America and similar settings.