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Ashenafi E, Guluma GB, Argaw D, Hareru HE, Soboksa NE. Nutritional outcomes of therapeutic feeding program and its predictors among undernourished adult HIV positive patients at healthcare facilities of West Guji Zone, Southern Ethiopia: A retrospective cohort study. PLoS One 2024; 19:e0297436. [PMID: 38261563 PMCID: PMC10805293 DOI: 10.1371/journal.pone.0297436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND For those living with HIV/AIDS, malnutrition is a significant issue everywhere, but it is particularly prevalent in Sub-Saharan Africa. A nutritional support program is becoming a more and more common strategy to prevent malnutrition in HIV-positive persons. Thus, this study aimed to assess nutritional treatment outcomes and their predictors among adult HIV-positive undernourished individuals in West Guji Zone healthcare facilities. METHOD A facility-based retrospective cohort study was conducted among 348 randomly selected adult HIV- positive patients in the West Guji Zone healthcare facilities between January 2018 and December 2022. Data were collected using the data extraction tool. Entered into Epi Data version 3.1 and exported to SPSS version 26 for analysis. The Kaplan-Meier survival curve and log-rank test were used to predict the time to recovery and to compare survival curves across categorical variables. A Cox proportional hazard regression model was fitted to identify an independent predictor of the recovery rate. Statistical significance was declared at a p-value of < 0.05. RESULTS In the final analysis 348 undernourished HIV-positive persons were included. Based on preset exit criteria, approximately 198, 56.9% of patients enrolled in the RUTF program were able to recovered, with an incidence of 9.83 (95% CI: 3.12, 13.44) per 100 person-month observations. Being divorced (AHR = 0.21; 95% CI: 0.06, 0.69) and being in the WHO advanced stage (AHR = 0.42; 95% CI: 0.23, 0.79) was a negative predictor. Being in the age range of 18-29 and 30-39 and having a working functional status (AHR = 2; 95% CI: 1.25, 3.23) were positive predictors. CONCLUSION Nutritional recovery in this study lower than WHO Sphere requirements. Age between 18 and 39 and working functional status were good indicators of nutritional recovery, whereas advanced WHO clinical stage and divorced marital status were negative predictors.
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Affiliation(s)
- Eden Ashenafi
- Department of Reproductive Health, College of Health and Medical Science, Dilla University, Dilla, Ethiopia
| | - Getahun Beyene Guluma
- School of Public Heath, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
- Adolescent Sexual and Reproductive Health Coordinator, Population Service International Ethiopia, Negele Arsi, Ethiopia
| | - Dirshaye Argaw
- School of Public Heath, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
| | - Habtamu Endashaw Hareru
- School of Public Heath, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
| | - Nagasa Eshete Soboksa
- Department of Environmental Health, College of Health and Medical Sciences, Dilla University, Dilla, Ethiopia
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Tadesse H, Toma A. Nutritional Treatment Outcomes of Therapeutic Feeding Program and Its Predictors Among HIV Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa City, Sidama, Southern Ethiopia: A Retrospective Cohort Study. HIV AIDS (Auckl) 2023; 15:83-93. [PMID: 36919023 PMCID: PMC10008424 DOI: 10.2147/hiv.s395936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023] Open
Abstract
Background HIV-induced malnutrition is highly prevalent in different parts of the world particularly in sub-Saharan Africa. The food intervention package is one of the strategies that targets malnutrition among HIV-infected people through nutritional evaluation, counseling and care. However, little is known concerning the outcomes of intervention in such patients in treatment program. Therefore, this study aimed to assess nutritional treatment outcomes and its predictors among adult HIV-positive undernourished individuals in Ethiopia. Methods Facility based retrospective cohort study was deployed in Adult Antiretroviral therapy clinic of Hawassa University Comprehensive Specialized Hospital. Data of 419 patients were extracted from the food by prescription registration book and patient cards using structured questionnaires. Statistical significance was assessed using Cox-proportional Hazard model by determining hazard ratios and 95% confidence interval. Results The proportion of adult HIV patients who recovered from malnutrition after they were enrolled in the food by prescription therapy was 53.0%. The variables found to have an association with good nutritional treatment outcomes of food by prescription in the final model are being female (Adjusted Hazard Ratio (AHR) = 3.38, 95% CI: 2.15, 5.32), secondary education (AHR = 2.16, 95% CI: 1.11, 4.18), tertiary education (AHR = 3.75, 95% CI: 1.66, 8.48), SAM (AHR = 0.20; 95% CI: 0.12, 0.35), and HAART (AHR = 2.70, 95% CI: 1.50, 4.86). Having Severe Acute Malnutrition (SAM) at baseline nutritional assessment (AHR = 3.42, 95% CI; 2.81, 5.15), taking ART for more than 12 months (AHR = 0.26, 95% CI: 0.13, 0.84) and starting HAART immediately after testing positive (AHR = 0.26, 95% CI: 0.13, 0.84) are significantly associated with nutritional treatment failure. Conclusion Fifty-three percent of HIV patients recovered from malnutrition after they were enrolled in the food by prescription therapy.
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Affiliation(s)
- Helen Tadesse
- Department of Human Nutrition, College of Agriculture, Hawassa University, Hawassa, Sidama, Ethiopia
| | - Alemayehu Toma
- School of Pharmacy, College of Medicine and Health Sciences, Hawassa University, Hawassa, Sidama, Ethiopia
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Zegeye MK, Belew AK, Aserese AD, Daba DB. Time to recovery from malnutrition and its predictors among human immunodeficiency virus positive children treated with ready-to-use therapeutic food in low resource setting area: A retrospective follow-up study. Health Sci Rep 2023; 6:e959. [PMID: 36467752 PMCID: PMC9708904 DOI: 10.1002/hsr2.959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 10/28/2022] [Accepted: 11/13/2022] [Indexed: 12/04/2022] Open
Abstract
Background and Aim Malnutrition is a serious public health issue and a frequent impact of human immunodeficiency virus (HIV) infection, which raises the risk of morbidity and mortality in affected people. Despite the World Health Organization's (WHO) support for the use of ready-to-use therapeutic foods (RUTF) to treat malnutrition, research on the length of time it takes for children with HIV infection to recover from malnutrition and the factors that predict it is lacking, particularly Ethiopia. Methods An institution-based retrospective follow-up study was carried out in the Amhara regional state referral hospitals in Northern Ethiopia. From 2013 to 2018, a total of 478 children who received RUTF treatments were chosen using a simple random sampling technique. To calculate the likelihood of recovery and the median recovery period, incidence and Kaplan-Meier survival analyses were performed. The Cox regression model was used to identify predictors of time to recovery from malnutrition. The multivariable model only included variables with a p value below 0.2. While factors were deemed to be substantially linked with the outcome variable if their p value was less than 0.05. Results The median recovery duration was 5 months (95% confidence interval [CI] = 4-5 months), and the nutritional recovery rate was 64.64% (95% CI = 60.2-68.9). Moderate acute malnutrition (adjusted hazard ratio [AHR] = 4.60, 95% [CI] = 2.85-7.43), WHO clinical stage I (AHR = 4.01, 95% CI = 1.37-11.77), absence of opportunistic infection (AHR = 1.76, 95% CI = 1.19-2.61), haemoglobin (Hgb) count above the threshold (AHR = 1.36, 95% CI = 1.01-1.85) and family size of 1-3 (AHR = 2.38, 95% CI = 2.38-5.00) were significantly linked to rapid recovery from malnutrition. Conclusion In comparison to the period specified by the national guideline (3 months for moderate and 6 months for severe acute malnutrition), the median time to recovery was lengthy. Acute malnutrition, clinical stage, opportunistic infection, Hgb count, and family size were statistically associated with early recovery from malnutrition.
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Affiliation(s)
- Martha kassahun Zegeye
- Department of Public HealthCollege of Medicine and Health Science, Ambo UniversityAmboEthiopia
| | | | - Addisalem Damtie Aserese
- Department of Public HealthCollege of Medicine and Health Science, Arbaminch UniversityArbamichEthiopia
| | - Derese Bekele Daba
- Department of Public HealthCollege of Medicine and Health Science, Ambo UniversityAmboEthiopia
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Alemu S, Zenu S, Tsegaye D. Time to Nutritional Recovery and Its Predictors Among Undernourished Adult Patients Living with Human Immune Deficiency Virus Attending Anti-Retroviral Therapy at Public Health Facilities in Southwest Ethiopia. A Multicenter Study. HIV AIDS (Auckl) 2022; 14:285-296. [PMID: 35726321 PMCID: PMC9206438 DOI: 10.2147/hiv.s366655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Infection with the human immunodeficiency virus is one of the factors that contribute to malnutrition. Several initiatives have been launched in Ethiopia to improve HIV patients’ nutritional status and achieve early recovery when malnourished patients are found. Despite these efforts, adult HIV patients’ malnutrition recovery remains poor. Objective The objective of this study was to assess the time to recovery from undernutrition and associated factors among adult HIV patients on ART at public health facilities in Ilu Aba Bor zone, Southwest Ethiopia, 2021. Methods An institution-based retrospective cohort study of 374 adult HIV patients with undernutrition receiving ART at public health institutions in Southwest Ethiopia was conducted. Data were extracted from the patient’s record and entered into Epi-Data version 3.1 before being exported to STATA version 14. The Kaplan–Meier method was used to estimate the time to recovery, and the difference in survival time between predictor variables was tested using the Log rank test. Weibull regression models, both bivariable and multivariable, were fitted. A p-value of 0.05 was declared statistically significant. Results The recovery rate was 67.7% and the median recovery time was 65 days (95% CI = 61.6–68.4) and 145 days (95% CI = 130.7–159) for MAM and SAM, respectively. Marital status (Married) (AHR = 0.61; CI = (0.43,0.86)), ART status (pre ART) AHR = 0.492; CI = (0.305,0.793), CD4 (200-350c/m3, AHR = 2.116;CI = (1.447,3.21), type of malnutrition (AHR = 0.22; CI= (0.156,0.307)), ART adherence level (AHR = 3.33, CI = (1.997,5.56)) WHO clinical staging (AHR = 0.685, CI = (0.485,0.948)), sex (male), (AHR = 0.678; CI = (0.509,0.901)) and age (35–54), (AHR = 1.86; CI = (1.408,2.47)) were predictors of recovery time. Conclusion Compared to previous studies, the recovery rate was high. SAM, advanced clinical stage, sex, and marital status were all negatively associated with nutritional recovery time, whereas ART adherence, CD4 count, and age were predictors. As a result, a therapeutic feeding program should focus on factors that slow recovery time.
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Affiliation(s)
- Soresa Alemu
- Departments of Public Health, College of Health Science, Mettu University, Mettu, Ethiopia
- Correspondence:, Soresa Alemu, Email
| | - Sabit Zenu
- Departments of Public Health, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Dereje Tsegaye
- Departments of Public Health, College of Health Science, Mettu University, Mettu, Ethiopia
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Tesfay FH, Javanparast S, Gesesew H, Mwanri L, Ziersch A. Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence. BMJ Open 2022; 12:e047205. [PMID: 34987036 PMCID: PMC8734022 DOI: 10.1136/bmjopen-2020-047205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Although some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa. DESIGN Systematic review. DATA SOURCES We searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers. ELIGIBILITY CRITERIA Studies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included. DATA EXTRACTION AND SYNTHESIS Data were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised. RESULTS Sixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified. CONCLUSIONS AND RECOMMENDATIONS Nutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed. PROSPERO REGISTRATION NUMBER CRD42020196827.
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Affiliation(s)
- Fisaha Haile Tesfay
- Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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Alebel A, Demant D, Petrucka P, Sibbritt D. Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e048022. [PMID: 34907042 PMCID: PMC8671928 DOI: 10.1136/bmjopen-2020-048022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Undernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA. METHODS AND ANALYSIS PubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger's and Begg's tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI. ETHICS AND DISSEMINATION Ethical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available. PROSPERO REGISTRATION NUMBER CRD42021277741.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Pammla Petrucka
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - David Sibbritt
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Woldie HG, Ketema DB, Ayana M, Alebel A. Predictors of recovery rate among undernourished HIV-positive adults treated with ready-to-use therapeutic food at Debre Markos Comprehensive Specialized Hospital: A retrospective cohort study. PLoS One 2021; 16:e0255465. [PMID: 34347849 PMCID: PMC8336829 DOI: 10.1371/journal.pone.0255465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 07/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Nutritional support is becoming more widely acknowledged as a crucial component of the key package of care for HIV/AIDS patients. This nutritional support is exceptionally important for patients in sub-Saharan Africa, including Ethiopia, where HIV/AIDS is very prevalent. However, there is a lack of evidence on the recovery rate and predictors at the study site and at large in Ethiopia. Therefore, this study will give some insight into the recovery rate and its predictors among under-nourished HIV-positive adults treated with Ready to Use Therapeutic Food (RUTF) attending at Debre Markos referral hospital. Moreover, the findings of this study will be used by both governmental and non-governmental organizations to allocate more resources to mitigate the nutritional problems for people living with HIV. METHODS An institution-based retrospective cohort study was conducted among 453 under-nourished HIV positive adults treated with RUTF at Debre Markos referral Hospital from the 1st of July, 2015 to the 31st of December, 2017. The study participants were selected using a simple random sampling technique. Data were extracted from patient charts using a standardized data extraction checklist. Data were entered into Epi-Data Version 4.2 and analyzed using Stata Version 14. The Kaplan-Meier survival curve was used to estimate the time to recovery. Log-rank test was used to compare the recovery time between different baseline categorical variables. The bivariable and multivariable Cox-proportional hazard regression models were fitted for potential predictors of recovery time. Adjusted hazard Ratios (AHRs) with 95% CIs were used to measure the strength of association and test statistical significance. RESULTS A total of 453 undernourished HIV-positive adults were included in the final analysis. About 201, 44.4% (95%CI: 38.9, 49.0%) patients participating in the RUTF program were recovered based on predetermined exit criteria with incidence of 10.65 (95% CI: 9.28, 12.23) per 100 person-month observations. Being moderately undernourished (AHR: 11.0, 95% CI: 5.3, 23.1), WHO clinical stage (I or II) (AHR:1.8, 95% CI: 1.2, 2.6), and working functional status at baseline (AHR = 2.34, 95%CI: 1.01,5.45) were predictors of recovery time. CONCLUSION This study concluded that the overall nutritional recovery rate was below the acceptable minimum requirement which at least 75% of patients should recovered. Mild to moderate undernutrition at baseline, WHO clinical stage I or II at enrolment, and working functional status were found to be predictors of recovery time in HIV/AIDS patients treated with the RUTF. As a result, special attention should be paid to severely malnourished patients, WHO clinical stages III or higher, and patients who are bedridden or ambulatory during treatment.
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Affiliation(s)
- Habtamu Gebremeskel Woldie
- Department of Hospital Pharmacy, Debre Markos Comprehensive Specialized Hospital, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- Department of Public Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Mulatu Ayana
- College of Medicine and Health Science, Ambo University, Ambo, Ethiopia
| | - Animut Alebel
- Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, Australia
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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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Tesfay FH, Ziersch A, Javanparast S, Mwanri L. Relapse into Undernutrition in a Nutritional Program in HIV Care and the Impact of Food Insecurity: A Mixed-Methods Study in Tigray Region, Ethiopia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E732. [PMID: 33467012 PMCID: PMC7829869 DOI: 10.3390/ijerph18020732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/17/2022]
Abstract
The relapse into undernutrition after nutritional recovery among those enrolled in a nutritional program is a common challenge of nutritional programs in HIV care settings, but there is little evidence on the determinants of the relapse. Nutritional programs in HIV care settings in many countries are not well designed to sustain the gains obtained from enrolment in a nutritional program. This study examined relapse into undernutrition and associated factors among people living with HIV in the Tigray region of Ethiopia. The study employed a mixed-methods approach, involving quantitative and qualitative studies. Among those who graduated from the nutritional program, 18% of adults and 7% of children relapsed into undernutrition. The mean time to relapse for adults was 68.5 months (95% CI, 67.0-69.9). Various sociodemographic, clinical, and nutritional characteristics were associated with a relapse into undernutrition. A considerable proportion of adults and children relapsed after nutritional recovery. Food insecurity and poor socioeconomic status were a common experience among those enrolled in the nutritional program. Hence, nutritional programs should design strategies to sustain the nutritional gains of those enrolled in the nutritional programs and address the food insecurity which was reported as one of the contributors to relapse into undernutrition among the program participants.
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Affiliation(s)
- Fisaha Haile Tesfay
- Institute of Health Transformation, Deakin University, Burwood, VIC 3125, Australia
- Southgate Institute for Health, Society and Equity, Flinders University, Bedford Park, SA 5042, Australia;
- School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, Bedford Park, SA 5042, Australia;
| | - Sara Javanparast
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (S.J.); (L.M.)
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia; (S.J.); (L.M.)
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Tekelehaimanot AN, Belachew T, Gudina EK, Getnet M, Amdisa D, Dadi LS. Intention Toward Dietary Diversity Among Adult People Living With HIV in Public Hospitals in Southwest Ethiopia Using Theory of Planned Behavior. A Mixed Methods Study. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2021; 58:469580211060805. [PMID: 34930043 PMCID: PMC8721683 DOI: 10.1177/00469580211060805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dietary diversity is a crucial element of an inclusive care for people living with HIV (PLWHIV), particularly in resource-limited countries where undernutrition, poor intention, and poor attitude toward diversified diets are the common challenges. The aim of this study was to assess the Intention toward dietary diversity behavior among adult PLWHIV in Jimma zone public hospitals, South West Ethiopia. A hospital-based survey was carried out in 5 public institutions among sampled 403 adult PLWHIV. Data were entered into EpiData, and exported to SPSS version 20 for analysis. Relationships among variables were assessed using correlation coefficients. The multivariable linear regression model was fitted to assess predictors of behavioral inclination toward dietary diversity at P-value ≤ .05. The quantitative data was supplemented by qualitative data, which was collected through key informant interviews and analyzed thematically. The significant predictors of intention to use dietary diversity were attitude (β = .196, P < .01) and subjective norm (β = .390, P < .01) of adult PLWHIV. The constructs of theory of planned behavior (TPB) independently explained the variance in inclination toward dietary diversity by 25.7%. All the intermediate, proximal, and distal components of TPB explained the final model with 32.2% of variance in the intention to use dietary diversity. The qualitative findings indicated that delivery of HIV care requires a drive for livelihood development and economic improvement, creating a sense of responsibility for sustainable HIV care by creating behavioral change at the individual level. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition. Conclusion: Dietary inadequacy was strongly correlated with being in the sociodemographic groups that are at heightened risk of adverse clinical outcomes. It is worthwhile to investigate behavioral intention as a potential determinant of the clinical outcomes rather than choose symptomatic treatment of malnutrition.
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Affiliation(s)
| | - Tefera Belachew
- Department of Population and Family health, Faculty of Public Health, Jimma University, Ethiopia
| | - Esayas Kebede Gudina
- Departments of Internal Medicine, Jimma Medical Center, Jimma University, Ethiopia
| | - Masrie Getnet
- Department of Epidemiology, Faculty of Public Health, Jimma University, Ethiopia
| | - Demuma Amdisa
- Department of Health Behavior and Society, Faculty of Public Health, Jimma University, Ethiopia
| | - Lelisa Sena Dadi
- Department of Epidemiology, Faculty of Public Health, Jimma University, Ethiopia
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Oumer Abdu A, Abebaw Mekonnen B. Episodes of Undernutrition and its Predictors among Clients on Antiretroviral Treatment in Southwest Ethiopia: A Record Review. HIV AIDS (Auckl) 2021; 13:61-71. [PMID: 33519243 PMCID: PMC7837580 DOI: 10.2147/hiv.s286609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/12/2020] [Indexed: 02/02/2023] Open
Abstract
Background More than a quarter of people living with human immune virus had increased burden of malnutrition leading to poor disease progression and survival. However, evidence on predictors for episodes of malnutrition is limited despite its importance for targeted interventions. This paper assessed the episodes of undernutrition and its predictors among HIV-positive adults on treatment in southwest Ethiopia. Methods A facility-based cross-sectional study using secondary data was conducted among 519 randomly selected records of adult clients on antiretroviral treatment. Malnutrition was assessed using the records of weight and height at different points of follow-up (0, 6, 12, 18, and 24 months of ART follow-up). Analysis of variance, covariance, and spaghetti plot were done to compare the mean change in body mass index. To assess predictors of malnutrition episodes, a linear mixed model was used with parameter estimate with 95% confidence interval and P-values were estimated via maximum likelihood method. Akaike's information criteria was used for model fitness. Results A total of 480 records were reviewed with a mean age of 36 years (±9 years). A total of 354 (73.8%) and 34.6% of clients got dietary counseling and support, respectively. Statistically significant improvement in mean BMI after initiating treatment (P-value=0.0001) was observed. Being male (β=−0.72; P=0.044), having problems of eating difficulty (β=−1.61; P=0.0001), anemia (β=−1.51; P=0.003), shorter follow-up intervals (β=0.04; P=0.129), not getting nutritional counseling (β=0.63; P=0.32), and diarrheal disease (β=−0.04; P=0.129) were predictors of undernutrition. Conclusion Improvement in nutritional status after initiation of ART was seen. The presence of eating disorder, anemia, not getting nutritional counseling, and the short follow-up interval predict undernutrition.
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Affiliation(s)
- Abdu Oumer Abdu
- Department of Public Health, College of Heath Sciences and Medicine, Wolkite University, Wolkite, Ethiopia
- Correspondence: Abdu Oumer Abdu Email
| | - Berhanu Abebaw Mekonnen
- Department of Nutrition and Dietetics, School of Public Heath, Bahir Dar University, Bahir Dar, Ethiopia
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Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study. AIDS Res Treat 2020; 2020:8861261. [PMID: 33489367 PMCID: PMC7794040 DOI: 10.1155/2020/8861261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia. Methods An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients' charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery. Result From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9–17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22–31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27–0.85), no formal education (ARR = 0.24, 95% CI: 0.13–0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08–0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17–0.59) decrease the probability of nutritional recovery. Conclusion Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.
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Tesfay F, Ziersch A, Mwanri L, Javanparast S. Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study. PLoS One 2020; 15:e0231859. [PMID: 32339181 PMCID: PMC7185904 DOI: 10.1371/journal.pone.0231859] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 04/02/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Addressing malnutrition is one of the key components of HIV care among people living with HIV. Since 2010, a nutritional program has been implemented to address malnutrition amongst HIV patients in Ethiopia, with patients enrolled in the program for 3 months (for mild acute malnutrition) and 6 months (for severe acute malnutrition). However, utilisation and effectiveness of the nutritional programs remain unexplored. This study aimed to examine individual level determinants and contextual factors influencing the effectiveness of the nutritional program in the Tigray region of Ethiopia. METHODS AND SETTING The study employed a mixed-methods approach involving quantitative and qualitative research methods. In the quantitative phase of the study, records from 1757 adult patients, including socio-demographic characteristics, clinical and nutritional program outcomes were retrieved from three selected hospitals in the Tigray region, Ethiopia. Logistic regression analysis was used to identify the individual demographic and socioeconomic, clinical and immunological, and anthropometric and nutritional determinants of nutritional outcomes. The qualitative study included 33 individual interviews with adult patients, health providers, and program managers. Interview data were analysed using a framework analysis approach. RESULTS Amongst study participants, 55.3% (95% CI = 53.2‒57.4) recovered from malnutrition, 19% (95% CI, 17.3‒20.7) did not complete the program, and 21% (95% CI = 19.7‒23.4) completed the program but failed to recover from malnutrition. In the multivariable logistic regression analysis, those who were: living in urban areas (AOR = 1.44, 95% CI = 1.05‒1.97), employed (AOR = 1.39, 95% CI = 1.01‒1.93), attending Shul (AOR = 4.6, 95% CI = 3.15‒6.71) and Lemlem Karl (AOR = 2.5, 95% CI = 1.69‒3.71) hospitals, in clinical stages II (AOR = 2.49, 95% CI = 1.59‒3.91) and III (AOR = 1.46(1.02‒2.07), on ART for less than six months (AOR = 1.61, 95% CI = 1.09‒2.39), anaemic (AOR = 1.77, 95% = 1.29‒2.41), and diagnosed with severe acute malnutrition at enrolment (AOR = 6.43, 95% CI = 4.69‒8.3); were less likely to complete the program. Results for those who completed the program indicated that urban residence, (AOR = 1.46, 95% CI = 1.4‒2.91), attending Shul (AOR = 2.92, 95% CI = 2.04‒4.19) and Lemlem Karl (AOR = 1.49, 95% CI 1.05‒2.11) hospitals, having bedridden functional status (AOR = 0.36, 95% CI = 0.15‒0.83), advanced WHO clinical stage (WHO clinical stage IV) (AOR = 0.52, 95% CI = 0.28‒0.98) and severe malnutrition at enrolment (AOR = 4.25, 95% CI = 3.02‒5.98)) predicted non-response to the nutritional program. Qualitative interviews revealed that the taste and perceived side effects of the nutritional supplement provided as part of the nutritional program, sharing/selling practices, religious and sociocultural issues, distance and poor access to the health services were barriers to program utilisation. Nutritional counselling and health service-related factors such as a previous enrolment in the program and positive experience in the health service were enablers of program utilisation. CONCLUSION There was a clear nexus between contextual factors such as distance, quality of health service and sociocultural factors, and individual patient characteristics with the effectiveness of the nutritional program. Taking individual and contextual factors into consideration in program design, planning and implementation is essential if the nutritional program in HIV care services is to achieve its goal in addressing malnutrition amongst people living with HIV.
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Affiliation(s)
- Fisaha Tesfay
- Southgate Institute for Health, Society and Equity, Flinders University- Australia, Bedford Park, Australia
- School of Public Health, Mekelle University–Ethiopia, Addis Ababa, Ethiopia
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University- Australia, Bedford Park, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University-Australia, Bedford Park, Australia
| | - Sara Javanparast
- College of Medicine and Public Health, Flinders University-Australia, Bedford Park, Australia
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Odwee A, Kasozi KI, Acup CA, Kyamanywa P, Ssebuufu R, Obura R, Agaba JB, Makeri D, Kirimuhuzya C, Sasirabo O, Bamaiyi PH. Malnutrition amongst HIV adult patients in selected hospitals of Bushenyi district in southwestern Uganda. Afr Health Sci 2020; 20:122-131. [PMID: 33402900 PMCID: PMC7750061 DOI: 10.4314/ahs.v20i1.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Malnutrition is an important clinical outcome amongst HIV patients in developing countries and in Uganda, there is scarcity of information on its prevalence and risk factors amongst HIV adult patients. METHODS A cross-sectional study amongst 253 HIV patients in Bushenyi district assessed their nutritional status using the body mass index (BMI) and mid-upper arm circumference (MUAC), and a questionnaire was used to identify major risk factors. RESULTS The mean age of the study participants was 38.74 ± 0.80 yrs, while females and males were 52.2% and 47.8% respectively. Prevalence of malnutrition was 10.28% (95% CI: 6.82 - 14.69) in the study. Major socio-economic factors associated with malnutrition were being female, unemployed, dependent and with many family members. Patients with opportunistic infections, low adherence to HAART, and stage of HIV/AIDS had a higher risk of malnutrition. DISCUSSION In rural communities, a majority of malnourished patients are elderly and these were identified as priority groups for HIV outreach campaigns. The current policy of prioritizing children and women is outdated due to changing disease dynamics, thus showing a need to revise extension service provision in rural communities. CONCLUSIONS Malnutrition is a threat in HIV adult patients in rural communities of Uganda.
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Affiliation(s)
- Ambrose Odwee
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Keneth Iceland Kasozi
- Department of Physiology, Faculty of Biomedical Sciences, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
| | - Christine Amongi Acup
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Patrick Kyamanywa
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Robinson Ssebuufu
- Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Richard Obura
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Jude B Agaba
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Danladi Makeri
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
| | - Claude Kirimuhuzya
- Department of Pharmacology, School of Pharmacy, Kampala International University Western Campus, Box 71 Bushenyi, Uganda
- Department of Pharmacology, School of Medicine, Kabale University, Kabale, Uganda
| | - Olivia Sasirabo
- School of Business and Management, Mountains of the Moon University, Box 837, Fort Portal, Uganda
| | - Pwaveno H Bamaiyi
- Department of Public Health, School of Allied Health and Sciences, Kampala International University Teaching Hospital, Box 71, Bushenyi, Uganda
- Postgraduate School and Research Directorate, Kampala International University Western Campus, Box 71, Bushenyi, Uganda
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Jos, Plateau State, Nigeria
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Nyamathi AM, Carpenter CL, Ekstrand ML, Yadav K, Garfin DR, Muniz LC, Kelley M, Sinha S. Randomized controlled trial of a community-based intervention on HIV and nutritional outcomes at 6 months among women living with HIV/AIDS in rural India. AIDS 2018; 32:2727-2737. [PMID: 30289802 PMCID: PMC6361536 DOI: 10.1097/qad.0000000000002016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the impact of nurse-led Asha (Accredited Social Health Activist)-support behavioral and nutritional intervention among women living with HIV/AIDS (WLH/A) in rural India. DESIGN Cluster randomized controlled trial. METHODS Sixteen Primary Health Centers serving WLH/A in Andhra Pradesh were grouped into four regional clusters that were randomly allocated into one of four arms. All four groups included Asha-support and consisted of: Asha-support only (control group); nutrition education; nutrition supplementation; and the combination of supplementation and education. Differences between baseline and 6-month follow-up for key physiological outcomes (BMI, CD4 cell count) were analyzed using factorial mixed models that accounted for geographic clustering. RESULTS At 6 months, all groups improved CD4 cell count: Asha only [mean difference score (D) = 343.97, standard deviation (SD) = 106.94], nutrition education (D = 356.15, SD = 0.69), nutrition supplement (D = 469.66, SD = 116.0), and nutrition supplement and education (D = 530.82, SD = 128.56). In multivariable models, Asha-support and nutrition, and Asha-support and nutrition supplement interventions demonstrated independent significant improvements in CD4 cell count; the interaction term was significant [estimate = 529.9; 95% confidence interval (CI) 512.0, 547.8; P = 0.006]. BMI also increased for all groups: Asha only (D = 0.95, SD = 0.82), Asha and nutrition education (D = 1.28, SD = 0.53), Asha and nutrition supplement (D = 2.38, SD = 0.60), nutrition supplement, and nutrition supplement and education (D = 2.72, SD = 0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (estimate = 0.27; 95% CI = 2.5, 2.7; P = 0.80). CONCLUSION Interventions supported by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.
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Affiliation(s)
| | | | - Maria L Ekstrand
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | - Sanjeev Sinha
- All India Institute of Medical Sciences, Department of Medicine, AIIMS Campus, New Delhi, India
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Hong H, Budhathoki C, Farley JE. Effectiveness of macronutrient supplementation on nutritional status and HIV/AIDS progression: A systematic review and meta-analysis. Clin Nutr ESPEN 2018; 27:66-74. [PMID: 30144895 PMCID: PMC6112859 DOI: 10.1016/j.clnesp.2018.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/21/2018] [Accepted: 06/22/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Malnutrition is common in Sub-Saharan Africa, weakening the immune function of persons living with HIV infection (PLWH). Being malnourished at the initiation of antiretroviral therapy (ART) leads to higher risk of early mortality and reduced quality of life. Thus, introduction of protein-energy-fortified macronutrient supplements at ART initiation may improve HIV treatment outcomes. This review aimed to evaluate the effectiveness of macronutrient interventions. METHODS This systematic review and meta-analysis included 15 studies conducted from 2000 to 2015 among Sub-Saharan African adults. RESULTS Six randomized controlled trials and 4 retrospective cohort studies provided data eligible for a meta-analysis. Supplementation significantly increased the overall standardized mean difference (SMD) between baseline and follow-up data in weight (SMD = 0.382, p < .001), BMI (SMD = 0.799, p < .001); fat-free mass (SMD = 0.154, p = .009); and CD4 count (SMD = 0.428, p < .001). CONCLUSION Protein-energy-fortified macronutrient supplementation at ART initiation may positively influence nutritional status and immunologic response in PLWH in Sub-Saharan Africa.
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Affiliation(s)
- Hyejeong Hong
- Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 North Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Nursing, The REACH Initiative, 1909 McElderry Street, SON House, Baltimore, MD, 21205, USA.
| | - Chakra Budhathoki
- Johns Hopkins University School of Nursing, Department of Acute and Chronic Care, 525 North Wolfe Street, Baltimore, MD, 21205, USA.
| | - Jason E Farley
- Johns Hopkins University School of Nursing, Department of Community-Public Health, 525 North Wolfe Street, Baltimore, MD, 21205, USA; Johns Hopkins University School of Nursing, The REACH Initiative, 1909 McElderry Street, SON House, Baltimore, MD, 21205, USA.
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17
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Cames C, Varloteaux M, Have NN, Diom AB, Msellati P, Mbaye N, Mbodj H, Sy Signate H, Diack A. Acceptability of Outpatient Ready-To-Use Food-Based Protocols in HIV-Infected Senegalese Children and Adolescents Within the MAGGSEN Cohort Study. Food Nutr Bull 2016; 38:27-36. [PMID: 27881690 DOI: 10.1177/0379572116679053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To assess the acceptability of ready-to-use food (RUF)-based outpatient protocols in HIV-infected children and adolescents with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). METHODS Plumpy Nut and Plumpy Sup were supplied every 2 weeks and prescribed by weight to SAM and MAM children, respectively. Forty-three children, 24 MAM and 19 SAM, were enrolled. Organoleptic appreciation, feeding modalities, and perceptions surrounding RUF were recorded at week 2. Sachets were counted to measure adherence throughout the study. RESULTS Median age was 12.2 years (interquartile range: 9.3-14.8), and 91% were on antiretroviral treatment. Overall, 80%, 76%, 68%, and 68% of children initially rated RUF color, taste, smell, and mouth feeling as good. However, feelings of disgust, refusal to eat, fragmentation of intake, self-stigma, and sharing within the household were commonly reported. Eighteen MAM and 7 SAM experienced weight recovery. Recovery duration was 54 days (31-90) in MAM versus 114 days (69-151) in SAM children ( P = .02). Their rate of RUF consumption compared to amount prescribed was approximately 50% from week 2 to week 10. Nine failed to gain weight or consume RUF and were discontinued for clinical management, and 9 dropped out due to distance to the clinic. CONCLUSION Initial RUF acceptability was satisfactory. More than half the children had successful weight recovery, although adherence to RUF prescription was suboptimal. However, further research is needed to propose therapeutic foods with improved palatability, alternative and simpler intervention design, and procedures for continuous and tailored psychosocial support in this vulnerable population. TRIAL REGISTRATION NCT01771562 (Current Controlled Trials).
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Affiliation(s)
- Cecile Cames
- 1 Institut de Recherche pour le Développement (IRD), UMI233 IRD, U1175 INSERM, Universite de Montpellier, Montpellier, France
| | - Marie Varloteaux
- 1 Institut de Recherche pour le Développement (IRD), UMI233 IRD, U1175 INSERM, Universite de Montpellier, Montpellier, France
| | - Ndeye Ngone Have
- 2 Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Alhadji Bassine Diom
- 3 Unite pediatrique de soin et d'accompagnement, Synergie pour l'Enfance - Hôpital Roi Baudouin, Guediawaye, Senegal
| | - Philippe Msellati
- 1 Institut de Recherche pour le Développement (IRD), UMI233 IRD, U1175 INSERM, Universite de Montpellier, Montpellier, France
| | - Ngagne Mbaye
- 3 Unite pediatrique de soin et d'accompagnement, Synergie pour l'Enfance - Hôpital Roi Baudouin, Guediawaye, Senegal
| | - Helene Mbodj
- 2 Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Haby Sy Signate
- 2 Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
| | - Aminata Diack
- 2 Centre Hospitalier National d'Enfants Albert Royer, Dakar, Senegal
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Rodas-Moya S, Pengnonyang S, Kodish S, de Pee S, Phanuphak P. Psychosocial factors influencing preferences for food and nutritional supplements among people living with HIV in Bangkok, Thailand. Appetite 2016; 108:498-505. [PMID: 27825956 DOI: 10.1016/j.appet.2016.10.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 10/26/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
Malnutrition and HIV are often coincident and may lead to wasting, a strong predictor of mortality. However; ready to use therapeutic foods (RUTF) are showing promising results in restoring the nutritional status of adult people living with HIV (PLHIV) in resource constrained settings but, its acceptability seems low. This study aimed to identify the psychosocial factors influencing general preferences for food and responses to five potential nutritional supplements to guide the development of novel products to treat malnutrition among PLHIV. This is a qualitative research based on Grounded Theory. In-depth interviews (IDIs) with a triangulation of data from different participants (i.e. PLHIV and Peer Counselors (PCs) were used as methods for data collection. During February-March 2013, 27 IDIs were conducted in the Anonymous Clinic of the Thai Red Cross and AIDS Research Center in Bangkok, Thailand. Five themes emerged: 1) local food culture is an important motive underlying the nutritional supplements choice by PLHIV; 2) food and drinks should have self-perceptible positive impact on health status and should be perceived convenient; 3) a soft and easy to swallow texture, softer scents and flavors are the major sensory characteristics guiding food and beverages choice; 4) food packaging characteristics affect nutritional supplement preference; 5) PCs may support nutritional supplement consumption. Similar findings emerged among PLHIV and PCs. This study highlights the need to develop a nutritional supplement considering the Thai culture and PLHIV's sensory preferences. A slightly thick liquid supplement, packed in small containers may be well-accepted. A combination of sensory studies and formative research should accompany the development of an alternative nutritional supplement for PLHIV. Results of this study might be transferable to similar sociocultural contexts.
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Affiliation(s)
- Santiago Rodas-Moya
- World Food Programme, Nutrition Unit, Via Cesare Giulio Viola 68, Parco dei Medici, 00148, Roma, Italy; Wageningen University, Division of Human Nutrition, Bomenweg 2, 6703 HD, Wageningen, The Netherlands.
| | - Supabhorn Pengnonyang
- Thai Red Cross AIDS Research Center, 04 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
| | - Stephen Kodish
- World Food Programme, Nutrition Unit, Via Cesare Giulio Viola 68, Parco dei Medici, 00148, Roma, Italy; Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States.
| | - Saskia de Pee
- World Food Programme, Nutrition Unit, Via Cesare Giulio Viola 68, Parco dei Medici, 00148, Roma, Italy; Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
| | - Praphan Phanuphak
- Thai Red Cross AIDS Research Center, 04 Ratchadamri Road, Pathumwan, Bangkok, 10330, Thailand.
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Bhagavathula AS, Tegegn HG, Dawson A, Elnour AA, Shehab A. Retention and Treatment Outcomes of an Undernutrition Program for HIV patients involving Ready-to-Use Therapeutic Food at Gondar University Hospital, Ethiopia: A Cross-Sectional Study. J Clin Diagn Res 2016; 10:LC01-6. [PMID: 27656469 DOI: 10.7860/jcdr/2016/19875.8294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 05/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Despite global efforts to eradicate poverty and hunger, under-nutrition is still a major health problem, especially in Sub-Saharan Africa, where HIV/AIDS prevalence is also a serious burden. AIM To assess the retention and outcomes of under-nutrition treatment program in Gondar University Hospital, Ethiopia. SETTINGS AND DESIGN A cross-sectional study was conducted in HIV positive children and adults participating in the Ready-to-use Therapeutic Food (RUTF) treatment program at Gondar University Hospital ART clinic for one year from November 2012 to November 2013. MATERIALS AND METHODS Six hundred and thirty six patient records were followed-up for one year. Outcome variables were Mid-Upper Arm Circumference (MUAC) values measured as severe, moderate acute malnutrition, normal after treatment, non-respondent, relapsed and lost to follow-up using the hospital records of HIV positive children and adults eligible for the program. STATISTICAL ANALYSIS Univariate and multivariate analysis were performed to compute Crude Odds Ratio (COR) and Adjusted Odds Ratio (AOR). Statistical significance was set at p-value<0.05. RESULTS Among 636 clients, 44.2% achieved MUAC measures ≥ 125 mm for children and ≥ 21 cm for adults at 4 and 6 months. 70.1% of those were children while 29.9% of the 281 were adults. Moreover, a more positive initial response to ready-to-use therapeutic food was found among children as there was significant increase (p<0.05) in MUAC value after the second month of initiating treatment while adults achieved a significant (p<0.05, p<0.01) in MUAC at the 4(th) and 6(th) month respectively. There was a significant association between age, nutrition status and treatment outcome, while sex, HIV status, education and residency were not associated with treatment outcome. CONCLUSION Recovery and weight gain rates were below 50%. Defaulter rates were higher than the Sphere standards and recovery was better in children than adults. Integrated RUTF and HIV program and strict follow-up and education or counselling of HIV positive patients should be strengthened.
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Affiliation(s)
- Akshaya Srikanth Bhagavathula
- Lecturer, Department of Clinical Pharmacy, University of Gondar-College of Medicine and Health Sciences , Gondar, Ethiopia
| | - Henok Getachew Tegegn
- Lecturer, Department of Clinical Pharmacy, University of Gondar-College of Medicine and Health Sciences , Gondar, Ethiopia
| | - Angela Dawson
- Professor, Faculty of Health, World Health Collaborating Centre, University of Technology , Sydney, Australia
| | - Asim Ahmed Elnour
- Associate Professor, Department of Clinical Pharmacy, Fathima College of Pharmacy , UAE
| | - Abdulla Shehab
- Associate Professor, Department of Internal Medicine, College of Medicine and Health Sciences - UAE University , Al Ain, UAE
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Mkwinda E, Lekalakala-Mokgele E. Palliative care needs in Malawi: Care received by people living with HIV. Curationis 2016; 39:1664. [PMID: 27381722 PMCID: PMC6091792 DOI: 10.4102/curationis.v39i1.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022] Open
Abstract
Background Infection with human immunodeficiency virus (HIV) has changed from an acute to a chronic illness in the past decade, because of highly active antiretroviral therapy (ART). Malawi’s response to the HIV challenge included provision of ART for people living with HIV or AIDS (PLWHA), which significantly reduced HIV- and AIDS-related mortality. In addition, palliative care for PLWHA was introduced as a strategy that improves the success of ART. Objective The purpose of the study was to explore the needs of PLWHA concerning care received from primary caregivers and palliative care nurses in Malawi. Methods A qualitative, explorative design was used and 18 participants were selected purposefully and interviewed individually using a semi-structured interview guide. Data were analysed using NVivo software package version 10. Results Results revealed that PLWHA needed physical care from the primary caregivers due to severity of illness, integration of healthcare services, and continuity of care and proper care from nurses. They also needed knowledge from nurses in several areas which affected decision-making and needed financial and nutritional support. Conclusion More could be done in meeting needs of PLWHA to improve their health and survival and assist them to achieve a better quality of life.
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Affiliation(s)
- Esmie Mkwinda
- Community Department, Kamuzu College of Nursing, University of Malawi, Lilongwe.
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Rodas-Moya S, Kodish S, Manary M, Grede N, de Pee S. Preferences for food and nutritional supplements among adult people living with HIV in Malawi. Public Health Nutr 2016; 19:693-702. [PMID: 26054934 PMCID: PMC10271136 DOI: 10.1017/s1368980015001822] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 02/04/2015] [Accepted: 04/29/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To elucidate the factors influencing food intake and preferences for potential nutritional supplements to treat mild and moderate malnutrition among adult people living with HIV (PLHIV). DESIGN Qualitative research using in-depth interviews with a triangulation of participants and an iterative approach to data collection. SETTING The study was conducted in a health clinic of rural Chilomoni, a southern town of Blantyre district, Malawi. SUBJECTS Male and female participants, aged 18-49 years (n 24), affected by HIV; health surveillance assistants of Chilomoni clinic (n 8). RESULTS Six themes emerged from the in-depth interviews: (i) PLHIV perceived having a poor-quality diet; (ii) health challenges determine the preferences of PLHIV for food; (iii) liquid-thick, soft textures and subtle natural colours and flavours are preferred; (iv) preferred organoleptic characteristics of nutritional supplements resemble those of local foods; (v) food insecurity may contribute to intra-household sharing of nutritional supplements; and (vi) health surveillance assistants and family members influence PLHIV's dietary behaviours. No differences by sex were found. The emergent themes were corroborated by health surveillance assistants through participant triangulation. CONCLUSIONS In this setting, a thickened liquid supplement, slightly sweet and sour, may be well accepted. A combination of quantitative and qualitative methods for data collection should follow to further develop the nutritional supplement and to fine tune the organoleptic characteristics of the product to the taste and requirements of PLHIV. Results of the present study provide a first approach to elucidate the factors influencing food intake and preferences for potential nutritional supplements among adult PLHIV.
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Affiliation(s)
- Santiago Rodas-Moya
- Policy and Programme Innovation Division, World Food Programme, Rome, Italy
- Division of Human Nutrition, Wageningen University, Bomenweg 2, Building 307, 6703 HD Wageningen, The Netherlands
| | - Stephen Kodish
- Policy and Programme Innovation Division, World Food Programme, Rome, Italy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Manary
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Nils Grede
- Country Office, World Food Programme, Jakarta, Indonesia
| | - Saskia de Pee
- Office of the Nutrition Advisor, World Food Programme, Rome, Italy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
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Daily consumption of ready-to-use peanut-based therapeutic food increased fat free mass, improved anemic status but has no impact on the zinc status of people living with HIV/AIDS: a randomized controlled trial. BMC Public Health 2016; 16:1. [PMID: 26728978 PMCID: PMC4700615 DOI: 10.1186/s12889-015-2639-8] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Food insecurity in sub-Saharan Africa and malnutrition constitute the main obstacles for successful treatment of people living with HIV/AIDS (PLWH). The aim of this study was to assess the effect of consuming daily 100 g RUTF (ready-to-use therapeutic food) as supplement, on body composition, anemia and zinc status of hospitalized PLWH in Senegal. Methods A Controlled clinical trial was conducted in 65 PLWH randomly allocated to receive either standard hospital diet alone (Control group: n = 33), or the standard diet supplemented with 100 g RUTF/day (RUTF group: n = 32). Supplementation was continued at home during 9 weeks. Individual dietary intakes were measured and compared to the Recommended Dietary Allowances. Body composition was determined using Bio-Impedance Analysis. Hemoglobin was measured by HemoCue and plasma zinc (PZ) concentration by atomic absorption spectrometry. PZ was adjusted to infection (CRP and α1-AGP). All measures were conducted on admission, discharge and after 9 weeks home-based follow up. Results 34 and 24 % of the patients in RUTF and Control groups were suffering from severe malnutrition (BMI < 16 kg/m2), respectively. In both groups, more than 90 % were anemic and zinc deficiency affected over 50 % of the patients. Food consumed by the Control group represented 75, 14 and 55 % of their daily recommended intake (DRI) of energy, iron and zinc, respectively. When 100 g of RUTF was consumed with the standard diet, the DRI of energy and zinc were 100 % covered (2147 kcal, 10.4 mg, respectively), but not iron (2.9 mg). After 9 weeks of supplementation, body weight, and fat-free mass increased significantly by +11 % (p = 0.033), and +11.8 % (p = 0.033) in the RUTF group, but not in the Control group, while percentage body fat was comparable between groups (p = 0.888). In the RUTF group, fat free mass gain is higher in the patients on ART (+11.7 %, n = 14; p = 0.0001) than in those without ART (+6.2 %, n = 6; p = 0.032). Anemia decreased significantly with the supplementation, but zinc status, measured using plasma zinc concentration, remained unchanged. Conclusion Improving PLWH’ diet with 100 g RUTF for a long period has a positive impact on muscle mass and anemia but not on the zinc status of the patients. Trial number NCT02433743, registered 29 April 2015.
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Abdissa A, Olsen MF, Yilma D, Tesfaye M, Girma T, Christiansen M, Hagen CM, Wiesner L, Castel S, Aseffa A, McIlleron H, Pedersen C, Friis H, Andersen AB. Lipid-based nutrient supplements do not affect efavirenz but lower plasma nevirapine concentrations in Ethiopian adult HIV patients. HIV Med 2015; 16:403-11. [PMID: 25974723 DOI: 10.1111/hiv.12225] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Lipid-based nutrient supplements (LNSs) are increasingly used in HIV programmes in resource-limited settings. However, the possible effects of LNSs on the plasma concentrations of antiretroviral drugs have not been assessed. Here, we aimed to assess the effects of LNSs on plasma efavirenz and nevirapine trough concentrations in Ethiopian adult HIV-infected patients. METHODS The effects of LNSs were studied in adults initiating antiretroviral therapy (ART) in a randomized trial. Patients with body mass index (BMI) > 17 kg/m(2) (n = 282) received daily supplementation of an LNS containing whey (LNS/w), an LNS containing soy (LNS/s) or no LNS. Trough plasma concentrations of efavirenz and nevirapine were measured at 1 and 2 months. Genotyping for 516 G>T and 983 T>C polymorphisms of the cytochrome P450 (CYP) 2B6 locus was performed. Multilevel linear mixed-effects models were used to assess the associations between LNS and plasma efavirenz and nevirapine concentrations. RESULTS In patients with BMI > 17 kg/m(2), nevirapine concentrations were lower in the LNS/w and LNS/s groups by a median of -2.3 μg/mL [interquartile range (IQR) -3.9; -0.9 μg/mL; P = 0.002] and -2.1 μg/mL (IQR -3.9; -0.9 μg/mL; P = 0.01), respectively, compared with the group not receiving supplements. There were no differences between groups with respect to efavirenz plasma concentrations. The CYP2B6 516 G>T polymorphism was associated with a 5 μg/mL higher plasma efavirenz concentration compared with the wild type (P < 0.0001), while it was not associated with plasma nevirapine concentrations. CONCLUSIONS Intake of an LNS was associated with lower plasma nevirapine trough concentrations, indicating possible drug-LNS interactions. The clinical relevance of such reductions in nevirapine exposure is not clear. Plasma efavirenz concentration was not affected by the LNS.
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Affiliation(s)
- A Abdissa
- Department of Medical Laboratory Sciences & Pathology, Jimma University, Jimma, Ethiopia.,Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - M F Olsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - D Yilma
- Department of Internal Medicine, Jimma University, Jimma, Ethiopia
| | - M Tesfaye
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | - T Girma
- Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia
| | - M Christiansen
- Department of Clinical Biochemistry and Immunology, Statens Serum Institute, Copenhagen, Denmark
| | - C M Hagen
- Department of Clinical Biochemistry and Immunology, Statens Serum Institute, Copenhagen, Denmark
| | - L Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - S Castel
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - A Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - H McIlleron
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - H Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - A B Andersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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Food supplementation among HIV-infected adults in Sub-Saharan Africa: impact on treatment adherence and weight gain. Proc Nutr Soc 2015; 74:517-25. [PMID: 25761769 DOI: 10.1017/s0029665115000063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sub-Saharan Africa has the highest proportion of undernourished people in the world, along with the highest number of people living with HIV and AIDS. Thus, as a result of high levels of food insecurity many HIV patients are also undernourished. The synergism between HIV and undernutrition leads to poor treatment adherence and high mortality rates. Undernutrition has a debilitating effect on the immune system due to key nutrient deficiencies and the overproduction of reactive species (oxidative stress), which causes rapid HIV progression and the onset of AIDS. Therapeutic food supplementation used in the treatment of severe acute malnutrition is being applied to HIV palliative care; however, little biochemical data exist to highlight its impact on oxidative stress and immune recovery. In addition, as most food supplements are imported by donor agencies, efforts are being put into local therapeutic food production such as the Food Multi-Mix concept to ensure sustainability. The purpose of this review is to highlight studies that examine the effectiveness of food supplementation in undernourished HIV patients in Sub-Saharan Africa; noting the parameters used to measure efficacy, as well as the long-term feasibility of supplementation.
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Dillon DG, Gurdasani D, Riha J, Ekoru K, Asiki G, Mayanja BN, Levitt NS, Crowther NJ, Nyirenda M, Njelekela M, Ramaiya K, Nyan O, Adewole OO, Anastos K, Azzoni L, Boom WH, Compostella C, Dave JA, Dawood H, Erikstrup C, Fourie CM, Friis H, Kruger A, Idoko JA, Longenecker CT, Mbondi S, Mukaya JE, Mutimura E, Ndhlovu CE, Praygod G, Pefura Yone EW, Pujades-Rodriguez M, Range N, Sani MU, Schutte AE, Sliwa K, Tien PC, Vorster EH, Walsh C, Zinyama R, Mashili F, Sobngwi E, Adebamowo C, Kamali A, Seeley J, Young EH, Smeeth L, Motala AA, Kaleebu P, Sandhu MS. Association of HIV and ART with cardiometabolic traits in sub-Saharan Africa: a systematic review and meta-analysis. Int J Epidemiol 2014; 42:1754-71. [PMID: 24415610 PMCID: PMC3887568 DOI: 10.1093/ije/dyt198] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Sub-Saharan Africa (SSA) has the highest burden of HIV in the world and a rising prevalence of cardiometabolic disease; however, the interrelationship between HIV, antiretroviral therapy (ART) and cardiometabolic traits is not well described in SSA populations. Methods We conducted a systematic review and meta-analysis through MEDLINE and EMBASE (up to January 2012), as well as direct author contact. Eligible studies provided summary or individual-level data on one or more of the following traits in HIV+ and HIV-, or ART+ and ART- subgroups in SSA: body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TGs) and fasting blood glucose (FBG) or glycated hemoglobin (HbA1c). Information was synthesized under a random-effects model and the primary outcomes were the standardized mean differences (SMD) of the specified traits between subgroups of participants. Results Data were obtained from 49 published and 3 unpublished studies which reported on 29 755 individuals. HIV infection was associated with higher TGs [SMD, 0.26; 95% confidence interval (CI), 0.08 to 0.44] and lower HDL (SMD, −0.59; 95% CI, −0.86 to −0.31), BMI (SMD, −0.32; 95% CI, −0.45 to −0.18), SBP (SMD, −0.40; 95% CI, −0.55 to −0.25) and DBP (SMD, −0.34; 95% CI, −0.51 to −0.17). Among HIV+ individuals, ART use was associated with higher LDL (SMD, 0.43; 95% CI, 0.14 to 0.72) and HDL (SMD, 0.39; 95% CI, 0.11 to 0.66), and lower HbA1c (SMD, −0.34; 95% CI, −0.62 to −0.06). Fully adjusted estimates from analyses of individual participant data were consistent with meta-analysis of summary estimates for most traits. Conclusions Broadly consistent with results from populations of European descent, these results suggest differences in cardiometabolic traits between HIV-infected and uninfected individuals in SSA, which might be modified by ART use. In a region with the highest burden of HIV, it will be important to clarify these findings to reliably assess the need for monitoring and managing cardiometabolic risk in HIV-infected populations in SSA.
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Affiliation(s)
- David G Dillon
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK, Genetic Epidemiology Group, Wellcome Trust Sanger Institute, Hinxton, Cambridge, UK, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Chronic Diseases Initiative in Africa, Department of Chemical Pathology, National Health Laboratory Service, University of the Witwatersrand Medical School, Johannesburg, South Africa, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, Department of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, Royal Victoria Teaching Hospital, School of Medicine, University of The Gambia, Banjul, The Gambia, Department of Medicine, Obafemi Awolowo University, Ile Ife, Nigeria, Women's Equity in Access to Care &Treatment, Kigali, Rwanda, HIV-1 Immunopathogenesis Laboratory, Wistar Institute, Philadelphia, PA, Tuberculosis Research Unit, Department of Medicine, Case Western Reserve University, Cleveland, OH, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy, Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa, Infectious Diseases Unit, Department of Medicine, Grey's Hospital, Pietermaritzburg, South Africa, Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark, HART (Hypertension in Africa Research Team), North-West University, Potchefstroom, South Africa, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark, Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa, Department of Medicine, Jos University Teachin
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Kebede MA, Haidar J. Factors influencing adherence to the food by prescription program among adult HIV positive patients in Addis Ababa, Ethiopia: a facility-based, cross-sectional study. Infect Dis Poverty 2014; 3:20. [PMID: 25035809 PMCID: PMC4101708 DOI: 10.1186/2049-9957-3-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 06/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One way of addressing malnutrition among HIV/AIDS patients is through the Food by Prescription program (FBP) and many studies have explained the treatment outcomes after therapeutic food supplementation, though available evidences on adherence levels and factors associated with these sorts of programs are limited. The findings of this study would therefore contribute to the existing knowledge on adherence to Ready-to-Use Therapeutic/Supplementary Food (RUF) in Ethiopia. METHODS A facility-based, cross-sectional study supplemented with qualitative methods was conducted among 630 adult HIV + patients. Their level of adherence to RUF was measured using the Morisky 8-item Medication Adherence Scale (MMAS-8). The total score on the MMAS-8 ranges from 0 to 8, with scores of <6, 6 to <8, and 8 reflecting low, medium, and high adherence, respectively. Patients who had a low or a moderate rate of adherence were considered non-adherent. RESULTS The level of adherence was found to be 36.3% with a 95.0% response rate. With the exception of the educational status, other socio-demographic variables had no significant effect on adherence. Those who knew the benefits of the FBP program were 1.78 times more likely to adhere to the therapy than the referent groups. On the other hand, patients who were not informed on the duration of the treatment, those prescribed with more than 2 sachets/day and had been taking RUF for more than 4 month were less likely to adhere. The main reasons for non-adherence were not liking the way the food tasted and missing follow-up appointments. Stigma and sharing and selling food were the other reasons, as deduced from the focus group discussion (FGD) findings. CONCLUSION The observed level of adherence to the FBP program among respondents enrolled in the intervention program was low. The major factors identified with a low adherence were a low level of education, poor knowledge on the benefits of RUF, the longer duration of the program, consuming more than two prescribed sachets of RUF per day, and not being informed about the duration of the treatment. Therefore, counseling patients on the program's benefits, including the treatment plans, would likely contribute to improved adherence.
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Affiliation(s)
| | - Jemal Haidar
- School of Public Health, Addis Ababa University, P.O. Box 27285/1000, Addis Ababa, Ethiopia
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"There is hunger in my community": a qualitative study of food security as a cyclical force in sex work in Swaziland. BMC Public Health 2014; 14:79. [PMID: 24460989 PMCID: PMC3905928 DOI: 10.1186/1471-2458-14-79] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 12/11/2013] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Swaziland has the highest HIV prevalence in the world - 32% of adults are currently living with HIV - and many Swazis are chronically food insecure - in 2011 one in four Swazis required food aid from the World Food Programme. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy (ART) adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. METHODS In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers. RESULTS Hunger was a major and consistent theme in our informants' lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access "healthy" foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession. CONCLUSIONS Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability to HIV and social marginalization, build sex workers collective efficacy to mobilize, consider poverty alleviation, and address social and policy level changes are necessary and likely to have the greatest success.
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Botros D, Somarriba G, Neri D, Miller TL. Interventions to address chronic disease and HIV: strategies to promote exercise and nutrition among HIV-infected individuals. Curr HIV/AIDS Rep 2013; 9:351-63. [PMID: 22933247 DOI: 10.1007/s11904-012-0135-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Food insecurity, micronutrient deficits, dyslipidemia, insulin resistance, obesity, cardiovascular disease, and bone disorders complicate the treatment of HIV infection. Nutrition and exercise interventions can be effective in ameliorating these symptoms that are associated with HIV and antiretroviral therapy (ART). In this literature review, we examine the most recent nutrition and exercise interventions for HIV-infected patients. Macronutrient supplementation can be useful in treating malnutrition and wasting. Multivitamin (vitamin B complex, vitamin C, and vitamin E) supplements and vitamin D may improve quality of life and decrease morbidity and mortality. Nutritional counseling and exercise interventions are effective for treating obesity, fat redistribution, and metabolic abnormalities. Physical activity interventions improve body composition, strength, and fitness in HIV-infected individuals. Taken collectively, the evidence suggests that a proactive approach to nutrition and physical activity guidance and interventions can improve outcomes and help abrogate the adverse metabolic, cardiovascular, and psychological consequences of HIV and its treatments.
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Affiliation(s)
- Diana Botros
- Division of Pediatric Clinical Research, Department of Pediatrics (D820), University of Miami, Miller School of Medicine, Batchelor Children's Research Institute, PO Box 016820, Miami, FL 33101, USA.
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Olsen MF, Tesfaye M, Kaestel P, Friis H, Holm L. Use, perceptions, and acceptability of a ready-to-use supplementary food among adult HIV patients initiating antiretroviral treatment: a qualitative study in Ethiopia. Patient Prefer Adherence 2013; 7:481-8. [PMID: 23766634 PMCID: PMC3680077 DOI: 10.2147/ppa.s44413] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Ready-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia. METHODS The study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF. RESULTS Participants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to "rebuild the body," and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with "medicinal qualities," which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences. CONCLUSION HIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients.
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Affiliation(s)
- Mette Frahm Olsen
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
- Correspondence: Mette Frahm Olsen, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Rolighedsvej 30, 1958 Frederiksberg C, Denmark Tel +45 3533 2531 Fax +45 3533 2483 Email
| | - Markos Tesfaye
- Department of Psychiatry, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
| | - Pernille Kaestel
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
| | - Lotte Holm
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Frederiksberg, Denmark
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Anema A, Zhang W, Wu Y, Elul B, Weiser SD, Hogg RS, Montaner JSG, El Sadr W, Nash D. Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries. Public Health Nutr 2012; 15:938-47. [PMID: 21806867 PMCID: PMC5341131 DOI: 10.1017/s136898001100125x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa. DESIGN In 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods. SETTING President's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries. SUBJECTS A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients. RESULTS Of the sites under study, 303 (90 %) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98 %, 64 %, 36 % and 31 % of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2.2, 95 % CI 1.1, 4.5). Rural sites (AOR: 2.3, 95 % CI 1.4, 3.8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2.4, 95 % CI 1.4, 4.1). Sites providing ART for >2 years (AOR: 1.6, 95 % CI 1.3, 1.9) and rural sites (AOR: 2.4, 95 % CI 1.4, 4.4) had greater odds of food ration availability. CONCLUSIONS Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.
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Affiliation(s)
- Aranka Anema
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada.
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Benova L, Fielding K, Greig J, Nyang'wa BT, Casas EC, da Fonseca MS, du Cros P. Association of BMI category change with TB treatment mortality in HIV-positive smear-negative and extrapulmonary TB patients in Myanmar and Zimbabwe. PLoS One 2012; 7:e35948. [PMID: 22545150 PMCID: PMC3335812 DOI: 10.1371/journal.pone.0035948] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 03/23/2012] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The HIV epidemic has increased the proportion of patients with smear-negative and extrapulmonary tuberculosis (TB) diagnoses, with related higher rates of poor TB treatment outcomes. Unlike in smear-positive pulmonary TB, no interim markers of TB treatment progress are systematically used to identify individuals most at risk of mortality. The objective of this study was to assess the association of body mass index (BMI) change at 1 month (±15 days) from TB treatment start with mortality among HIV-positive individuals with smear-negative and extrapulmonary TB. METHODS AND FINDINGS A retrospective cohort study of adult HIV-positive new TB patients in Médecins Sans Frontières (MSF) treatment programmes in Myanmar and Zimbabwe was conducted using Cox proportional hazards regression to estimate the association between BMI category change and mortality. A cohort of 1090 TB patients (605 smear-negative and 485 extrapulmonary) was followed during TB treatment with mortality rate of 28.9 per 100 person-years. In multivariable analyses, remaining severely underweight or moving to a lower BMI category increased mortality (adjusted hazard ratio 4.05, 95% confidence interval 2.77-5.91, p<0.001) compared with remaining in the same or moving to a higher BMI category. CONCLUSIONS We found a strong association between BMI category change during the first month of TB treatment and mortality. BMI category change could be used to identify individuals most at risk of mortality during TB treatment among smear-negative and extrapulmonary patients.
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Affiliation(s)
- Lenka Benova
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | | | - Jane Greig
- Médecins Sans Frontières, London, United Kingdom
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