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Celeste-Villalvir A, Palar K, Then-Paulino A, Wallace DD, Jimenez-Paulino G, Fulcar MA, Acevedo R, Derose KP. Perceived Impacts of Urban Gardens and Peer Nutritional Counseling for People Living With HIV in the Dominican Republic. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:478-488. [PMID: 38613552 PMCID: PMC11227956 DOI: 10.1016/j.jneb.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Explore participants' perceptions of urban gardens and peer nutritional counseling intervention for people with HIV and food insecurity on antiretroviral therapy in the Dominican Republic. METHODS Semistructured endline interviews (n = 21) with intervention participants about their perceptions of diet, health, and quality of life. A codebook was applied to verbatim transcripts, and coded data were analyzed using matrices to identify themes. RESULTS Participants were mostly Dominican (86%; 14% Haitian); 57% were men; the mean age was 45 years. The most salient experiences described by intervention participants were improved dietary quality and diversity, improved food security, and saving money. Participants also emphasized improved social interactions, mental health, and emotional well-being. CONCLUSIONS AND IMPLICATIONS Urban gardens and peer nutritional counseling may improve participants' diet and psychosocial well-being. Nutrition programs with marginalized populations may need to improve access to healthy foods and build camaraderie and linkages to programs addressing structural factors.
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Affiliation(s)
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Deshira D Wallace
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Maria Altagracia Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Ramon Acevedo
- Consejo Nacional para el VIH y Sida, Santo Domingo, Dominican Republic
| | - Kathryn P Derose
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA; Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA.
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Okusanya TR, Okoka EM, Kuyebi MA, Oyadiran OT, Kowe T, Noor RA, Omotayo MO, Abioye AI. Nutrition counselling and clinical outcomes in HIV: A systematic review and meta-analysis. HIV Med 2024; 25:462-478. [PMID: 38158600 DOI: 10.1111/hiv.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND People living with the HIV (PLHIV) are at an increased risk of various diseases due to a weakened immune system, particularly if they are naïve or poorly adherent to antiretroviral therapy (ART). Nutrients play a critical role in improving immune health, especially among this population. We systematically reviewed the evidence concerning the impact of nutritional counselling on the occurrence of important clinical outcomes among PLHIV. METHODS Medical literature databases (PubMed, EMBASE and Web of Science) were searched from inception to October 2022 for relevant published studies (n = 12) of nutritional counselling and HIV-related outcomes in adults on ART. Random-effects meta-analyses were conducted when the exposure-outcome relationships were similar in three or more studies. RESULTS Although the methodologies of nutritional intervention varied across all studies, overall, the evidence from the meta-analysis indicates a nsignificant positive association between nutrition counselling and improvements in CD4 cell count, body mass index and low-density lipoprotein concentration. However, the existing literature does not provide enough evidence to establish a significant impact of nutrition counselling on other immune, anthropometric, and metabolic outcomes including viral load, weight, and lean mass due to the differences in the study designs. CONCLUSION Well-powered randomized controlled trials are needed that explore the effect of evidence-based, individualized nutrition counselling on HIV-related clinical outcomes.
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Rezazadeh L, Ostadrahimi A, Tutunchi H, Naemi Kermanshahi M, Pourmoradian S. Nutrition interventions to address nutritional problems in HIV-positive patients: translating knowledge into practice. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:94. [PMID: 37684634 PMCID: PMC10492288 DOI: 10.1186/s41043-023-00440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection and malnutrition negatively reinforce each other. Malnutrition leads to further immune deficiency and accelerates disease progression. The present overview aimed to investigate the current knowledge from review articles on the role of nutrition interventions as well as food and nutrition policies on HIV-related outcomes in adults to present future strategies for strengthening food and nutrition response to HIV. METHODS We searched PubMed/Medline, Scopus, Embase, ProQuest, and Ovid databases using the relevant keywords. The search was limited to studies published in English until April 2022. All types of reviews studies (systematic review, narrative review, and other types of review studies) which evaluated the impact of nutritional program/interventions on HIV progression were included. RESULTS Although nutrition programs in HIV care have resulted in improvements in nutritional symptoms and increase the quality life of HIV patients, these programs should evaluate the nutritional health of HIV-infected patients in a way that can be sustainable in the long term. In additions, demographic, clinical, and nutritional, social characteristics influence nutritional outcomes, which provide potential opportunities for future research. CONCLUSION Nutrition assessment, education and counseling, and food supplements where necessary should be an integral part of HIV treatment programs.
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Affiliation(s)
- Leila Rezazadeh
- Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Department of Clinical Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Helda Tutunchi
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Naemi Kermanshahi
- Student Research Committee, Nutrition Research Center, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samira Pourmoradian
- Nutrition Research Center, Department of Community Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
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4
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Abioye AI, Hughes MD, Sudfeld CR, Noor RA, Isanaka S, Lukmanji Z, Mugusi F, Fawzi WW. Dietary Iron Intake and HIV-Related Outcomes Among Adults Initiating Antiretroviral Therapy in Tanzania. J Acquir Immune Defic Syndr 2023; 94:57-65. [PMID: 37199401 PMCID: PMC10524611 DOI: 10.1097/qai.0000000000003221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/19/2022] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Anemia is highly prevalent among people living with HIV (PLWHIV) and is often due to iron deficiency. This study evaluated the relationship of dietary iron intake levels and sources with mortality and clinical outcomes among adults initiating HAART. DESIGN We conducted a secondary analysis of a multivitamin supplementation trial among 2293 PLWHIV initiating HAART in Dar es Salaam, Tanzania. METHODS Dietary iron intake was assessed with a food frequency questionnaire at HAART initiation, and participants followed until death or censoring. Total, animal-, and plant-sourced iron were categorized into quartiles. Intake of food groups was categorized into 0-1, 2-3, and ≥4 servings/wk. Cox proportional hazards models estimated hazard ratios for mortality and incident clinical outcomes. RESULTS There were 175 deaths (8%). Red meat intake was associated with a lower risk of all-cause mortality (HR: 0.54; 95% CI: 0.35 to 0.83), AIDS-related mortality (HR: 0.49; 95% CI: 0.28 to 0.85), and severe anemia (HR: 0.57; 95% CI: 0.35 to 0.91), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Legume intake was a lower risk of associated with all-cause mortality (HR: 0.49; 95% CI: 0.31 to 0.77) and AIDS-related mortality (HR: 0.37; 95% CI: 0.23 to 0.61), when intake ≥4 servings/wk, compared with 0-1 servings/wk. Although total dietary iron and overall plant-sourced iron intake were not associated with the risk of mortality or HIV-related outcomes, the highest quartile of animal-sourced iron intake was associated with a lower risk of all-cause mortality (HR: 0.56; 95% CI: 0.35 to 0.90) and a lower risk of AIDS-related mortality (HR: 0.50; 95% CI: 0.30 to 0.90), compared with the lowest quartile. CONCLUSION Intake of iron-rich food groups may be associated with a lower risk of mortality and critical HIV-related outcomes among adults initiating HAART. TRIAL REGISTRATION The parent trial was registered at Clinicaltrials.gov . Identifier: NCT00383669.
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Affiliation(s)
| | | | - Christopher R Sudfeld
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Sheila Isanaka
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
| | | | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; and
| | - Wafaie W Fawzi
- Departments of Nutrition
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
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Schwartz NB, Yilma D, Girma T, Tesfaye M, Mølgaard C, Michaelsen KF, Kæstel P, Friis H, Olsen MF. Lipid-based nutrient supplement at initiation of antiretroviral therapy does not substitute energy from habitual diet among HIV patients – a secondary analysis of data from a randomised controlled trial in Ethiopia. Food Nutr Res 2022; 66:5659. [PMID: 35291724 PMCID: PMC8886435 DOI: 10.29219/fnr.v66.5659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 08/20/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Malnutrition is common among people with HIV in sub-Saharan Africa. Nutritional supplementation at initiation of antiretroviral treatment (ART) has shown beneficial effects, but it is not known if supplementation replaces or supplements the habitual energy intake in a context of food insecurity.
Methods: As part of a randomised controlled trial among people with HIV initiating ART in Ethiopia, we assessed whether the provision of a lipid-based nutrient supplement (LNS) affected energy intake from the habitual diet. People with HIV aged ≥18 years with a body mass index (BMI) >17 were randomly allocated 2:1 to receive either early (month 1–3 after ART initiation) or delayed (month 4–6 after ART initiation) supplementation with LNS (≈4,600 kJ/day). Participants with BMI 16–17 were all allocated to early supplementation. The daily energy intake from the habitual diet (besides the energy contribution from LNS) was assessed using a 24-h food recall interview at baseline and at monthly follow-up visits. Linear mixed models were used to compare habitual energy intake in (1) early versus delayed supplementation groups and (2) supplemented versus unsupplemented time periods within groups.
Results: Of 301 participants included, 67% of the participants were women, mean (±standard deviation [SD]) age was 32.9 (±8.9) years and 68% were living in moderately or severely food insecure households. Mean (±SD) reported habitual energy intake at baseline was 5,357 kJ/day (±2,246) for women and 7,977 kJ/day(±3,557) for men. Among all participants, there were no differences in mean habitual energy intake between supplemented and unsupplemented groups in neither the first 3 (P = 0.72) nor the following 3 months (P = 0.56). Furthermore, habitual energy intake did not differ within groups when comparing periods with or without supplementation (P = 0.15 and P = 0.20). The severity of food insecurity did not modify the effect of supplementation in habitual energy intake (P = 0.55). Findings were similar when participants with BMI 16–17 were excluded.
Conclusion: Our findings indicate that the LNS provided after ART initiation supplement, rather than substitute, habitual energy intake among people with HIV, even among those who are food insecure. This supports the feasibility of introducing nutritional supplementation as part of HIV treatment.
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Affiliation(s)
- Nanna Buhl Schwartz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Nanna Buhl Schwartz, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, 1958 Frederiksberg C, Denmark.
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University Specialized Hospital, Jimma, Ethiopia
| | - Tsinuel Girma
- Department of Paediatric and Child Health, Jimma University Specialized Hospital, Jimma, Ethiopia
| | - Markos Tesfaye
- Department of Psychiatry, St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Christian Mølgaard
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | - Pernille Kæstel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Denmark
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Sakthivel R, Rajendran S. The effect of nurse initiated nutritional counselling with hatha yoga on nutritional status of HIV infected adolescents: Randomized controlled trial. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2022. [DOI: 10.4103/jnms.jnms_94_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Tesfay FH, Ziersch A, Mwanri L, Javanparast S. Experience of nutritional counselling in a nutritional programme in HIV care in the Tigray region of Ethiopia using the socio-ecological model. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2021; 40:34. [PMID: 34321102 PMCID: PMC8317349 DOI: 10.1186/s41043-021-00256-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In many resource-poor settings, nutritional counselling is one of the key components of nutrition support programmes aiming to improve nutritional and health outcomes amongst people living with HIV. Counselling methods, contents and recommendations that are culturally appropriate, locally tailored and economically affordable are essential to ensure desired health and nutritional outcomes are achieved. However, there is little evidence showing the effectiveness of counselling in nutritional programmes in HIV care, and the extent to which counselling policies and guidelines are translated into practice and utilised by people with HIV suffering from undernutrition. This study aimed to explore these gaps in the Tigray region of Ethiopia. METHODS AND PARTICIPANTS A qualitative study was conducted in Tigray region Ethiopia between May and August 2016. Forty-eight individual interviews were conducted with 20 undernourished adults living with HIV and 15 caregivers of children living with HIV enrolled in a nutritional programme in three hospitals, as well as 11 health providers, and 2 programme managers. Data analysis was undertaken using the Framework approach and guided by the socio-ecological model. Qualitative data analysis software (QSR NVivo 11) was used to assist data analysis. The study findings are presented using the consolidated criteria for the reporting of qualitative research (COREQ). RESULT The study highlighted that nutritional counselling as a key element of the nutritional programme in HIV care varied in scope, content, and length. Whilst the findings clearly demonstrated the acceptability of the nutritional counselling for participants, a range of challenges hindered the application of counselling recommendations in participants' everyday lives. Identified challenges included the lack of comprehensiveness of the counselling in terms of providing advice about the nutritional support and dietary practice, participants' poor understanding of multiple issues related to nutrition counselling and the nutrition programme, lack of consistency in the content, duration and mode of delivery of nutritional counselling, inadequate refresher training for providers and the absence of socioeconomic considerations in nutritional programme planning and implementation. Evidence from this study suggests that counselling in nutritional programmes in HIV care was not adequately structured and lacked a holistic and comprehensive approach. CONCLUSION Nutritional counselling provided to people living with HIV lacks comprehensiveness, consistency and varies in scope, content and duration. To achieve programme goal of improved nutritional status, counselling guidelines and practices should be structured in a way that takes a holistic view of patient's life and considers cultural and socioeconomic situations. Additionally, capacity development of nutritional counsellors and health providers is highly recommended to ensure counselling provides assistance to improve the nutritional well-being of people living with HIV.
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Affiliation(s)
- Fisaha Haile Tesfay
- Institute for Health Transformation, Deakin University, Geelong, Melbourne, Australia.
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia.
- School of Public Health, Mekelle University, Mekelle, Ethiopia.
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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8
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Bast ES, Stonbraker S, Halpern M, Lowenthal E, Gross R. Barriers to HIV treatment adherence among adults living with HIV in the eastern Dominican Republic. Int J STD AIDS 2021; 32:1014-1019. [PMID: 33990170 DOI: 10.1177/09564624211014102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite access to nationally supplied antiretroviral treatment, viral load suppression rates remain suboptimal in the Dominican Republic. Counseling and support services are available but mainly targeted to those identified as having the most need. At Clínica de Familia La Romana (CFLR) in La Romana, all patients undergo a structured baseline interview including exploration of expected barriers to care. We conducted a retrospective cohort study of a random sample of patients at CFLR with treatment initiation between 1 January 2015 and 1 December 2017 to determine if self-identified barriers to HIV care predict viral load suppression. Viral load suppression occurred in 63% of the 203 patients evaluated. Lack of food (n = 19) was significantly associated with lack of viral suppression (OR 3.0, 95% CI 1.14-7.87). Nondisclosure of HIV status (n = 24) showed evidence for a protective effect (OR 0.33; 95% CI 0.11-1.0). Further steps should be taken to address food insecurity as well as to understand associated barriers to care among individuals with food insecurity.
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Affiliation(s)
- Elizabeth S Bast
- 19994Bruce W Carter Department of Veterans Affairs Medical Center, Miami, FL, USA
| | - Samantha Stonbraker
- Clinica de Familia La Romana, La Romana, Dominican Republic.,University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO, USA
| | - Mina Halpern
- Clinica de Familia La Romana, La Romana, Dominican Republic
| | - Elizabeth Lowenthal
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA.,Global Health Center, 547315Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, 14640University of Pennsylvania, Philadelphia, PA, USA
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Mbuagbaw L, Hajizadeh A, Wang A, Mertz D, Lawson DO, Smieja M, Benoit AC, Alvarez E, Puchalski Ritchie L, Rachlis B, Logie C, Husbands W, Margolese S, Zani B, Thabane L. Overview of systematic reviews on strategies to improve treatment initiation, adherence to antiretroviral therapy and retention in care for people living with HIV: part 1. BMJ Open 2020; 10:e034793. [PMID: 32967868 PMCID: PMC7513605 DOI: 10.1136/bmjopen-2019-034793] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 07/01/2020] [Accepted: 08/07/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We sought to map the evidence and identify interventions that increase initiation of antiretroviral therapy, adherence to antiretroviral therapy and retention in care for people living with HIV at high risk for poor engagement in care. METHODS We conducted an overview of systematic reviews and sought for evidence on vulnerable populations (men who have sex with men (MSM), African, Caribbean and Black (ACB) people, sex workers (SWs), people who inject drugs (PWID) and indigenous people). We searched PubMed, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Web of Science and the Cochrane Library in November 2018. We screened, extracted data and assessed methodological quality in duplicate and present a narrative synthesis. RESULTS We identified 2420 records of which only 98 systematic reviews were eligible. Overall, 65/98 (66.3%) were at low risk of bias. Systematic reviews focused on ACB (66/98; 67.3%), MSM (32/98; 32.7%), PWID (6/98; 6.1%), SWs and prisoners (both 4/98; 4.1%). Interventions were: mixed (37/98; 37.8%), digital (22/98; 22.4%), behavioural or educational (9/98; 9.2%), peer or community based (8/98; 8.2%), health system (7/98; 7.1%), medication modification (6/98; 6.1%), economic (4/98; 4.1%), pharmacy based (3/98; 3.1%) or task-shifting (2/98; 2.0%). Most of the reviews concluded that the interventions effective (69/98; 70.4%), 17.3% (17/98) were neutral or were indeterminate 12.2% (12/98). Knowledge gaps were the types of participants included in primary studies (vulnerable populations not included), poor research quality of primary studies and poorly tailored interventions (not designed for vulnerable populations). Digital, mixed and peer/community-based interventions were reported to be effective across the continuum of care. CONCLUSIONS Interventions along the care cascade are mostly focused on adherence and do not sufficiently address all vulnerable populations.
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Affiliation(s)
- Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Centre for the Develoment of Best Practices in Health, Yaounde Central Hospital, Yaounde, Cameroon
| | - Anisa Hajizadeh
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Annie Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of Rheumatology, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marek Smieja
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anita C Benoit
- Women's College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Alvarez
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Lisa Puchalski Ritchie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
| | - Beth Rachlis
- Division of Clinical Public Health, Dalla Lana School of Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Logie
- Women's College Research Institute, Toronto, Ontario, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Shari Margolese
- Canadian HIV Trials Network Community Advisory Committee, Vancouver, British Columbia, Canada
| | - Babalwa Zani
- Knowledge Translation Unit, University of Cape Town Lung Institute, Rondebosch, Western Cape, South Africa
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
- Pediatrics and Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicine, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada
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10
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Hauner H. [Which diet during the Corona pandemic?]. MMW Fortschr Med 2020; 162:57-60. [PMID: 32405836 PMCID: PMC7220599 DOI: 10.1007/s15006-020-0480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Die aktuelle Corona-Pandemie betrifft nahezu alle Bereiche der Medizin und des täglichen Lebens. Dementsprechend häufig tauchen Fragen zum Stellenwert der Ernährung auf, z. B. welche Ernährung einen Schutz vor der Corona-Infektion bieten kann und welche Bedeutung die Ernährung im Krankheitsverlauf hat.
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Affiliation(s)
- Hans Hauner
- Institut für Ernährungsmedizin Else Kröner-Fresenius-Zentrum für Ernährungsmedizin, Klinikum rechts der Isar der TU München, Georg-Brauchle-Ring 62, D-80992, München, Deutschland.
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11
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Musayón-Oblitas FY, Cárcamo CP, Gimbel S, Zarate JIE, Espinoza ABG. Validation of a counseling guide for adherence to antiretroviral therapy using implementation science. Rev Lat Am Enfermagem 2020; 28:e3228. [PMID: 32022148 PMCID: PMC7000190 DOI: 10.1590/1518-8345.3117.3228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 09/16/2019] [Indexed: 11/22/2022] Open
Abstract
Objective: to determine the contents that must be included in the usual counseling to
improve the adherence to antiretroviral therapy (ART) of HIV patients,
according to their different levels of alcohol consumption, and to determine
the validity of the Counseling Guide in improving the adherence to ART in
patients who consume alcohol using Implementation Science. Method: this is an observational study with formative and validation phases. The
formative phase defined the content, approach and structure of the
counseling. Validation included focus groups with patients and nurses, trial
process by an expert and a pilot test. The criteria evaluated based on
Implementation Science were: intervention source, evidence strength and
quality, relative advantage, and complexity. The following criteria were
also evaluated: usefulness, practicality, acceptability, sustainability,
effectiveness; content consistency and congruence; procedural compliance and
difficulties, and time spent in counseling. Results: the strength of evidence of the counseling is High-IIA, with strong level of
recommendation and presenting usefulness, practicality, acceptability,
sustainability and effectiveness. Eight in 11 experts argued that the Guide
is clear, consistent and congruent. Initial counseling takes around 24
minutes; and follow-up counseling, 21. The instruments of the Guide present
reliability levels between good and high (0.65 ≥ alpha ≤ 0.92). Conclusion: the Counseling Guide is valid to improve the adherence to antiretroviral
therapy in patients who consume alcohol.
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Affiliation(s)
| | - Cesar Paul Cárcamo
- Universidad Peruana Cayetano Heredia, Facultad de Salud Pública y Administración "Carlos Vidal Layseca", Lima, LIM, Peru
| | - Sarah Gimbel
- University of Washington, Department of Global Health, Washington, WA, Estados Unidos da América
| | | | - Ana Beatriz Graña Espinoza
- Hospital Cayetano Heredia, Estrategia Sanitaria Nacional de Prevención y Control de Infecciones de Transmisión Sexual, VIH y SIDA, Lima, LIM, Peru
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Derose KP, Palar K, Farías H, Adams J, Martínez H. Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research. Food Nutr Bull 2018; 39:549-563. [PMID: 30453759 DOI: 10.1177/0379572118809302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC). OBJECTIVE To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy. METHODS Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects. RESULTS Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists. CONCLUSION High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.
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Affiliation(s)
| | - Kartika Palar
- 2 Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Hugo Farías
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Jayne Adams
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- 1 RAND Corporation, Santa Monica, CA, USA.,4 Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,5 Nutrition International, Ottawa, Canada
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Mallewa J, Szubert AJ, Mugyenyi P, Chidziva E, Thomason MJ, Chepkorir P, Abongomera G, Baleeta K, Etyang A, Warambwa C, Melly B, Mudzingwa S, Kelly C, Agutu C, Wilkes H, Nkomani S, Musiime V, Lugemwa A, Pett SL, Bwakura-Dangarembizi M, Prendergast AJ, Gibb DM, Walker AS, Berkley JA. Effect of ready-to-use supplementary food on mortality in severely immunocompromised HIV-infected individuals in Africa initiating antiretroviral therapy (REALITY): an open-label, parallel-group, randomised controlled trial. Lancet HIV 2018; 5:e231-e240. [PMID: 29653915 PMCID: PMC5932190 DOI: 10.1016/s2352-3018(18)30038-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/28/2018] [Accepted: 03/01/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND In sub-Saharan Africa, severely immunocompromised HIV-infected individuals have a high risk of mortality during the first few months after starting antiretroviral therapy (ART). We hypothesise that universally providing ready-to-use supplementary food (RUSF) would increase early weight gain, thereby reducing early mortality compared with current guidelines recommending ready-to-use therapeutic food (RUTF) for severely malnourished individuals only. METHODS We did a 2 × 2 × 2 factorial, open-label, parallel-group trial at inpatient and outpatient facilities in eight urban or periurban regional hospitals in Kenya, Malawi, Uganda, and Zimbabwe. Eligible participants were ART-naive adults and children aged at least 5 years with confirmed HIV infection and a CD4 cell count of fewer than 100 cells per μL, who were initiating ART at the facilities. We randomly assigned participants (1:1) to initiate ART either with (RUSF) or without (no-RUSF) 12 weeks' of peanut-based RUSF containing 1000 kcal per day and micronutrients, given as two 92 g packets per day for adults and one packet (500 kcal per day) for children aged 5-12 years, regardless of nutritional status. In both groups, individuals received supplementation with RUTF only when severely malnourished (ie, body-mass index [BMI] <16-18 kg/m2 or BMI-for-age Z scores <-3 for children). We did the randomisation with computer-generated, sequentially numbered tables with different block sizes incorporated within an online database. Randomisation was stratified by centre, age, and two other factorial randomisations, to 12 week adjunctive raltegravir and enhanced anti-infection prophylaxis (reported elsewhere). Clinic visits were scheduled at weeks 2, 4, 8, 12, 18, 24, 36, and 48, and included nurse assessment of vital status and symptoms and dispensing of all medication including ART and RUSF. The primary outcome was mortality at week 24, analysed by intention to treat. Secondary outcomes included absolute changes in weight, BMI, and mid-upper-arm circumference (MUAC). Safety was analysed in all randomly assigned participants. Follow-up was 48 weeks. This trial is registered with ClinicalTrials.gov (NCT01825031) and the ISRCTN registry (43622374). FINDINGS Between June 18, 2013, and April 10, 2015, we randomly assigned 1805 participants to treatment: 897 to RUSF and 908 to no-RUSF. 56 (3%) were lost-to-follow-up. 96 (10·9%, 95% CI 9·0-13·1) participants allocated to RUSF and 92 (10·3%, 8·5-12·5) to no-RUSF died within 24 weeks (hazard ratio 1·05, 95% CI 0·79-1·40; log-rank p=0·75), with no evidence of interaction with the other randomisations (both p>0·7). Through 48 weeks, adults and adolescents aged 13 years and older in the RUSF group had significantly greater gains in weight, BMI, and MUAC than the no-RUSF group (p=0·004, 0·004, and 0·03, respectively). The most common type of serious adverse event was specific infections, occurring in 90 (10%) of 897 participants assigned RUSF and 87 (10%) of 908 assigned no-RUSF. By week 48, 205 participants had serious adverse events in both groups (p=0·81), and 181 had grade 4 adverse events in the RUSF group compared with 172 in the non-RUSF group (p=0·45). INTERPRETATION In severely immunocompromised HIV-infected individuals, providing RUSF universally at ART initiation, compared with providing RUTF to severely malnourished individuals only, improved short-term weight gain but not mortality. A change in policy to provide nutritional supplementation to all severely immunocompromised HIV-infected individuals starting ART is therefore not warranted at present. FUNDING Joint Global Health Trials Scheme (UK Medical Research Council, UK Department for International Development, and Wellcome Trust).
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Affiliation(s)
- Jane Mallewa
- Department/College of Medicine and Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Alexander J Szubert
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | - Ennie Chidziva
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Margaret J Thomason
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | | | | | | | | | - Colin Warambwa
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Betty Melly
- Moi University School of Medicine, Eldoret, Kenya
| | | | - Christine Kelly
- Department/College of Medicine and Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Clara Agutu
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Helen Wilkes
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Sanele Nkomani
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | | | - Sarah L Pett
- Medical Research Council Clinical Trials Unit at University College London, London, UK; The Kirby Institute, University of New South Wales, Sydney, Australia
| | | | | | - Diana M Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
| | - A Sarah Walker
- Medical Research Council Clinical Trials Unit at University College London, London, UK.
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Sackey J, Zhang FF, Rogers B, Aryeetey R, Wanke C. Implementation of a nutrition assessment, counseling and support program and its association with body mass index among people living with HIV in Accra, Ghana. AIDS Care 2017; 30:586-590. [PMID: 29284281 DOI: 10.1080/09540121.2017.1420137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In spite of the important role nutrition plays in the management of HIV, access to nutrition services is inadequate, especially in resource limited settings. In addition, nutrition programs for people living with HIV (PLWH) have not been sufficiently evaluated for efficacy and this study was conducted to address this gap. This study aimed to evaluate the implementation of the nutrition assessment, counseling and support (NACS) program in Accra, Ghana, and to assess whether the level of implementation of NACS was associated with the body mass index (BMI) of PLWH. A cross-sectional study was conducted in six HIV clinics (3 NACS designated and 3 non-NACS). Study participants were 152 adult PLWH at least 6 months on antiretroviral therapy and not pregnant or breastfeeding. Using a NACS implementation scale developed for this study ranging from 0 to 8 (a higher score indicating better NACS implementation), median NACS implementation score was not different between NACS-designated, and non-NACS HIV clinics (5 vs 4, p = 0.14). Almost half (47%) of the respondents were overweight or obese. A higher score on the NACS implementation scale was not significantly associated with overweight or obesity (BMI >24.9 kg/m2) after adjusting for other covariates. It was concluded that, there was poor implementation of NACS in the NACS designated HIV clinics surveyed with no nutrition counseling offered nor food support available to those who might need it.
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Affiliation(s)
- Joachim Sackey
- a Department of Nutritional Sciences , Rutgers School of Health Professsions , Newark , NJ , USA
| | - Fang Fang Zhang
- b Friedman School of Nutrition Science and Policy , Tufts University , Boston , MA , USA
| | - Beatrice Rogers
- b Friedman School of Nutrition Science and Policy , Tufts University , Boston , MA , USA
| | - Richmond Aryeetey
- c School of Public Health , University of Ghana, Legon , Accra , Ghana
| | - Christine Wanke
- d Department of Public Health and Community Medicine , Tufts University School of Medicine , Boston , MA , USA
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15
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Thuppal SV, Jun S, Cowan A, Bailey RL. The Nutritional Status of HIV-Infected US Adults. Curr Dev Nutr 2017; 1:e001636. [PMID: 29955683 PMCID: PMC5998784 DOI: 10.3945/cdn.117.001636] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/30/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022] Open
Abstract
Background: Nutrition is critical to HIV mortality and morbidity. Improved treatment modalities have increased life expectancy of HIV-infected individuals. More than 1 million US adults are living with HIV, but little is known about their nutritional status. Objective: We aimed to characterize the nutritional status of those living with HIV with the use of the NHANES 2003-2014. Methods: The NHANES is a nationally representative, cross-sectional survey of the US population and includes a household interview, medical examination, and two 24-h dietary recalls; survey weights are applied to make the data nationally representative. HIV antibodies were ascertained initially by immunoassay and confirmed with Western blot. NHANES 2003-2014 data were analyzed for HIV-positive (n = 87) and HIV-negative (n = 15,868) US adults (aged 19-49 y). Body mass index (BMI), waist circumference, dietary intakes, and nutritional biomarkers were estimated and compared by HIV status, stratified by sex. Results: HIV-infected men and women had higher serum protein, lower serum albumin, and lower serum folate than did non-HIV-infected adults. HIV-positive women had significantly higher BMI, prevalence of overweight or obesity, and waist circumference risk and substantially lower serum 25-hydroxyvitamin D concentrations (44 compared with 65 nmol/L) than did HIV-negative women. When compared with HIV-negative women, HIV-positive women had lower intakes of some key nutrients such as fiber, vitamin E, vitamin K, magnesium, and potassium but had higher intakes of protein and niacin. Conclusions: The NHANES data suggest that HIV infection is associated with poorer markers of some nutritional status indicators; however, the US population prevalence of HIV is <0.5%. Given the small sample size, not only in this study but also in the United States, much more targeted research is needed to better understand the multitude of factors that influence the nutritional status among those living with HIV in the United States, especially among women.
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Affiliation(s)
| | - Shinyoung Jun
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Alexandra Cowan
- Department of Nutrition Science, Purdue University, West Lafayette, IN
| | - Regan L Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, IN
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16
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Webel AR, Perazzo JD, Dawson-Rose C, Smith C, Nicholas PK, Rivero-Méndez M, Solís-Báez SS, Eller LS, Johnson MO, Corless IB, Lindgren T, Holzemer WL, Kemppainen JK, Reid P, Mogobe KD, Matshediso E, Nokes K, Portillo CJ. A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV. Appl Nurs Res 2017; 37:13-18. [PMID: 28985914 DOI: 10.1016/j.apnr.2017.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/07/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
Globally, people living with HIV (PLWH) are at remarkably high risk for developing chronic comorbidities. While exercise and healthy eating reduce and mitigate chronic comorbidites, PLWH like many others, often fail to engage in recommended levels. We qualitatively examined the perspectives and contextual drivers of diet and exercise reported by PLWH and their health care providers. Two hundred and six participants across eight sites in the United States, Puerto Rico and Botswana described one overarching theme, Arranging Priorities, and four subthemes Defining Health, Perceived Importance of Diet and Exercise, Competing Needs, and Provider Influence. People living with HIV and their health care providers recognize the importance of eating a healthy diet and engaging in regular exercise. Yet there are HIV-specific factors limiting these behaviors that should be addressed. Health care providers have an important, and often underutilized opportunity to support PLWH to make improvements to their exercise and diet behavior.
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Affiliation(s)
- Allison R Webel
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue Cleveland, OH 44122, USA.
| | - Joseph D Perazzo
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue Cleveland, OH 44122, USA
| | - Carol Dawson-Rose
- University of California San Francisco, School of Nursing, Dept. of Community Health Systems San Francisco, CA, USA
| | - Carolyn Smith
- Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue Cleveland, OH 44122, USA
| | - Patrice K Nicholas
- Brigham and Women's Hospital and MGH Institute of Health Professions Boston, USA
| | | | | | | | - Mallory O Johnson
- University of California San Francisco, School of Nursing, Dept. of Community Health Systems San Francisco, CA, USA
| | - Inge B Corless
- Brigham and Women's Hospital and MGH Institute of Health Professions Boston, USA
| | | | | | | | - Paula Reid
- University of North Carolina Wilmington Wilmington, NC, USA
| | | | - Ella Matshediso
- Faculty of Health Sciences University of Botswana, 00712, Gaborone, Botswana
| | | | - Carmen J Portillo
- University of California San Francisco, School of Nursing, Dept. of Community Health Systems San Francisco, CA, USA
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Kabagambe EK, Ezeamama AE, Guwatudde D, Campos H, Fawzi W. Plasma n-6 Fatty Acid Levels Are Associated With CD4 Cell Counts, Hospitalization, and Mortality in HIV-Infected Patients. J Acquir Immune Defic Syndr 2016; 73:598-605. [PMID: 27529612 PMCID: PMC5110389 DOI: 10.1097/qai.0000000000001149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Fatty acids, including n-6 series, modulate immune function, but their effect on CD4 cell counts, death, or hospitalization in HIV-infected patients on antiretroviral therapy is unknown. METHODS In a randomized trial for effects of multivitamins in HIV-infected patients in Uganda, we used gas chromatography to measure plasma n-6 fatty acids at baseline; determined CD4 counts at baseline, 3, 6, 12, and 18 months; and recorded hospitalization or death events. The associations of fatty acids with CD4 counts and events were analyzed using repeated-measures analysis of variance and Cox regression, respectively. RESULTS Among 297 patients with fatty acids measurements, 16 patients died and 69 were hospitalized within 18 months. Except for linoleic acid, n-6 fatty acids levels were positively associated with CD4 counts at baseline but not during follow-up. In models that included all 5 major n-6 fatty acids, age; sex; body mass index; anemia status; use of antiretroviral therapy, multivitamin supplements, and alcohol; and the risk of death or hospitalization decreased significantly with an increase in linoleic acid and gamma-linolenic acid levels, whereas associations for dihomo-gamma-linolenic acid, arachidonic acid, and aolrenic acid were null. The hazard ratios (95% confidence intervals) per 1 SD increase in linoleic acid and gamma-linolenic acid were 0.73 (0.56-0.94) and 0.51 (0.36-0.72), respectively. Gamma-linolenic acid remained significant (hazard ratio = 0.51; 95% confidence interval: 0.35 to 0.68) after further adjustment for other plasma fatty acids. CONCLUSIONS Lower levels of gamma-linolenic acid are associated with lower CD4 counts and an increased risk of death or hospitalization. These results suggest a potential for using n-6 fatty acids to improve outcomes from antiretroviral therapy.
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Affiliation(s)
- Edmond K Kabagambe
- Division of Epidemiology, Department of Medicine and the Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37203
| | - Amara E Ezeamama
- Department of Epidemiology and Biostatistics, The University of Georgia, Athens, GA 30602
| | - David Guwatudde
- Department of Epidemiology and Biostatistics (DG), School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Hannia Campos
- Department of Nutrition and Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115
| | - Wafaie Fawzi
- Department of Nutrition and Departments of Global Health and Population and Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115
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Whittle HJ, Palar K, Seligman HK, Napoles T, Frongillo EA, Weiser SD. How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area. Soc Sci Med 2016; 170:228-236. [PMID: 27771206 DOI: 10.1016/j.socscimed.2016.09.040] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 09/12/2016] [Accepted: 09/28/2016] [Indexed: 02/06/2023]
Abstract
RATIONALE Food-insecure people living with HIV/AIDS (PLHIV) consistently exhibit worse clinical outcomes than their food-secure counterparts. This relationship is mediated in part through non-adherence to antiretroviral therapy (ART), sub-optimal engagement in HIV care, and poor mental health. An in-depth understanding of how these pathways operate in resource-rich settings, however, remains elusive. OBJECTIVE We aimed to understand the relationship between food insecurity and HIV health among low-income individuals in the San Francisco Bay Area using qualitative methods. METHODS Semi-structured in-depth interviews were conducted with 34 low-income PLHIV receiving food assistance from a non-profit organization. Interviews explored experiences with food insecurity and its perceived effects on HIV-related health, mental health, and health behaviors including taking ART and attending clinics. Thematic content analysis of transcripts followed an integrative inductive-deductive approach. RESULTS Food insecurity was reported to contribute to poor ART adherence and missing scheduled clinic visits through various mechanisms, including exacerbated ART side effects in the absence of food, physical feelings of hunger and fatigue, and HIV stigma at public free-meal sites. Food insecurity led to depressive symptoms among participants by producing physical feelings of hunger, aggravating pre-existing struggles with depression, and nurturing a chronic self-perception of social failure. Participants further explained how food insecurity, depression, and ART non-adherence could reinforce each other in complex interactions. CONCLUSION Our study demonstrates how food insecurity detrimentally shapes HIV health behavior and outcomes through complex and interacting mechanisms, acting via multiple socio-ecological levels of influence in this setting. The findings emphasize the need for broad, multisectoral approaches to tackling food insecurity among urban poor PLHIV in the United States.
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Affiliation(s)
- Henry J Whittle
- Global Health Sciences, University of California, San Francisco (UCSF), Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States.
| | - Kartika Palar
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States
| | - Hilary K Seligman
- Center for Vulnerable Populations at San Francisco General Hospital, Division of General Internal Medicine, UCSF, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States
| | - Tessa Napoles
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, 915 Greene Street, Room 529, Columbia, SC 29208, United States
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, United States; Center for AIDS Prevention Studies, UCSF, Mission Hall/Global Health and Clinical Sciences Building, 550 16th Street, 3rd Floor, San Francisco, CA 94158-2549, United States
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Noor RA, Geldsetzer P, Bärnighausen T, Fawzi W. Do countries rely on the World Health Organization for translating research findings into clinical guidelines? A case study. Global Health 2016; 12:58. [PMID: 27716252 PMCID: PMC5053105 DOI: 10.1186/s12992-016-0196-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 09/09/2016] [Indexed: 01/01/2023] Open
Abstract
Background The World Health Organization’s (WHO) antiretroviral therapy (ART) guidelines have generally been adopted rapidly and with high fidelity by countries in sub-Saharan Africa. Thus far, however, WHO has not published specific guidance on nutritional care and support for (non-pregnant) adults living with HIV despite a solid evidence base for some interventions. This offers an opportunity for a case study on whether national clinical guidelines in sub-Saharan Africa provide concrete recommendations in the face of limited guidance by WHO. This study, therefore, aims to determine if national HIV treatment guidelines in sub-Saharan Africa contain specific guidance on nutritional care and support for non-pregnant adults living with HIV. Methods We identified the most recent national HIV treatment guidelines in sub-Saharan African countries with English as an official language. Using pre-specified criteria, we determined for each guideline whether it provides guidance to clinicians on each of five components of nutritional care and support for adults living with HIV: assessment of nutritional status, dietary counseling, micronutrient supplementation, ready-to-use therapeutic or supplementary foods, and food subsidies. Results We found that national HIV treatment guidelines in sub-Saharan Africa generally do not contain concrete recommendations on nutritional care and support for non-pregnant adults living with HIV. Conclusions Given that decisions on nutritional care and support are inevitably being made at the clinician-patient level, and that clinicians have a relative disadvantage in systematically identifying, summarizing, and weighing up research evidence compared to WHO and national governments, there is a need for more specific clinical guidance. In our view, such guidance should at a minimum recommend daily micronutrient supplements for adults living with HIV who are in pre-ART stages, regular dietary counseling, periodic assessment of anthropometric status, and additional nutritional management of undernourished patients. More broadly, our findings suggest that countries in sub-Saharan Africa look to WHO for guidance in translating evidence into clinical guidelines. It is, thus, likely that the development of concrete recommendations by WHO on nutritional interventions for people living with HIV would lead to more specific guidelines at the country-level and, ultimately, better clinical decisions and treatment outcomes.
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Affiliation(s)
- Ramadhani A Noor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Africa Academy for Public Health (AAPH), Plot #802, Mwai Kibaki Road, Dar es Salaam, Tanzania
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Africa Health Research Institute, Mtubatuba, 3935, South Africa.,Institute of Public Health, Heidelberg University, 69120, Heidelberg, Germany
| | - Wafaie Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA02115, USA
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20
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Tesfaye M, Kaestel P, Olsen MF, Girma T, Yilma D, Abdissa A, Ritz C, Michaelsen KF, Hanlon C, Friis H. The effect of nutritional supplementation on quality of life in people living with HIV: a randomised controlled trial. Trop Med Int Health 2016; 21:735-42. [PMID: 27115126 DOI: 10.1111/tmi.12705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the effects of lipid-based nutrient supplements (LNS) on the quality of life of people living with HIV (PLHIV) during the first 3 months of antiretroviral treatment (ART) and to investigate the effects of timing of supplementation by comparing with supplementation during the subsequent 3 months. METHODS A randomised controlled trial was conducted in three ART clinics within public health facilities in Jimma, Ethiopia. Participants were PLHIV eligible to start ART with body mass index >17 kg/m(2) and given daily supplements of 200 g of LNS containing whey or soya either during the first 3 months or the subsequent months of ART. The outcome was measured in terms of total quality-of-life scores on the adapted version of the WHOQOL-HIV-BREF assessed at baseline, three and six months. RESULTS Of the 282 participants, 186 (66.0%) were women. The mean age (SD) was 32.8 (±9.0) years, and the mean (SD) total quality-of-life score was 82.0 (±14.8) at baseline assessment. At 3 months, participants who received LNS showed better quality of life than those who only received ART without LNS (β = 6.2, 95% CI: 2.9: 9.6). At 6 months, there was no difference in total quality-of-life score between the early and delayed supplementation groups (β = 3.0, 95% CI: -0.4: 6.4). However, the early supplementation group showed higher scores on the social and spirituality domains than the delayed group. CONCLUSIONS LNS given during the first three months of ART improves the quality of life of PLHIV.
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Affiliation(s)
- Markos Tesfaye
- Department of Psychiatry, College of Health Science, Jimma University, Jimma, Ethiopia
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Kaestel
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Tsinuel Girma
- Department of Pediatrics and Child Health, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Alemseged Abdissa
- Department of Medical Laboratory Sciences & Pathology, College of Health Science, Jimma University, Jimma, Ethiopia
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Hanlon
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
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