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Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries

  • Aranka Anema (a1) (a2), Wendy Zhang (a1), Yingfeng Wu (a3), Batya Elul (a3) (a4), Sheri D Weiser (a5), Robert S Hogg (a1) (a6), Julio SG Montaner (a1) (a2), Wafaa El Sadr (a3) (a4) and Denis Nash (a3) (a4)...

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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Copyright

Corresponding author

*Corresponding author: Email aanema@cfenet.ubc.ca

References

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1. Joint United Nations Programme on HIV/AIDS (2010) UNAIDS report on the global AIDS epidemic. http://www.unaids.org/documents/20101123_GlobalReport_em.pdf (accessed July 2011).
2. Hogg, RS, Heath, KV, Yip, B et al. (1998) Improved survival among HIV-infected individuals following initiation of antiretroviral therapy. JAMA 279, 450454.
3. Hogg, RS, Yip, B, Chan, KJ et al. (2001) Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA 286, 25682577.
4. Lima, VD, Hogg, RS, Harrigan, PR et al. (2007) Continued improvement in survival among HIV-infected individuals with newer forms of highly active antiretroviral therapy. AIDS 21, 685692.
5. World Health Organization (2010) Towards Universal Access: scaling up priority HIV/AIDS interventions in the health sector: progress report. http://whqlibdoc.who.int/publications/2010/9789241500395_eng.pdf (accessed July 2011).
6. United Nations Food and Agriculture Organization (2010) The state of food insecurity in the world: addressing food insecurity in protracted crises. http://www.fao.org/docrep/013/i1683e/i1683e.pdf (accessed July 2011).
7. World Food Programme, World Health Organization, Joint United Nations Programme on HIV/AIDS (2008) HIV, food security and nutrition: policy brief expanded version. http://www.data.unaids.org/pub/.../2008/jc1565_policy_brief_nutrition_long_en.pdf (accessed July 2011).
8. United Nations Administrative Committee on Coordination Sub-Committee on Nutrition (2000) Fourth Report on the World Nutrition Situation: Nutrition Throughout the Lifecycle. Geneva: ACC/SCN; available at: http://www.unscn.org/layout/modules/resources/files/rwns4.pdf/
9. Ahoua, L, Umutoni, C, Huerga, H et al. (2011) Nutrition outcomes of HIV-infected malnourished adults treated with ready-to-use therapeutic food in sub-Saharan Africa: a longitudinal study. J Int AIDS Soc 14, 19.
10. Uthman, OA (2008) Prevalence and pattern of HIV-related malnutrition among women in sub-Saharan Africa: a meta analysis of demographic health surveys. BMC Public Health 8, 226.
11. Magadi, MA (2011) Cross-national analysis of the risk factors of child malnutrition among children made vulnerable by HIV/AIDS in sub-Saharan Africa: evidence from the DHS. Trop Med Int Health 16, 570578.
12. Gillespie, S & Kadiyala, S (2005) HIV/AIDS and Food and Nutrition Security: From Evidence to Action. Washington, DC: IFPRI.
13. Bukusuba, J, Kikafunda, JK & Whitehead, RG (2007) Food security status in households of people living with HIV/AIDS (PLWHA) in a Ugandan urban setting. Br J Nutr 98, 211217.
14. Food and Nutrition Technical Assistance (2007) Recommendation for the nutrient requirements for people living with HIV/AIDS. www.fantaproject.org/.../Nutrient_Requirements_HIV_Feb07.pdf (accessed July 2011).
15. World Food Programme (2003) Programming in the era of AIDS: WPF's response to HIV/AIDS. http://www.wfp.org/sites/default/files/Programming%20in%20the%20Era%20of%20AIDS%20WFP's%20Response%20to%20HIV:AIDS.pdf (accessed July 2011).
16. Salomon, J, de Truchis, P & Melchior, JC (2002) Body composition and nutritional parameters in HIV and AIDS patients. Clin Chem Lab Med 40, 13291333.
17. Kotler, DP, Tierney, AR, Brenner, SK et al. (1990) Preservation of short-term energy balance in clinically stable patients with AIDS. Am J Clin Nutr 51, 713.
18. Mangili, A, Murman, SH, Zampini, M et al. (2006) Nutrition and HIV infection: review of weight loss and wasting in the era of highly active antiretroviral therapy from the nutrition for healthy living cohort. Clin Infect Dis 42, 836842.
19. Grinspoon, S & Mulligan, K (2003) Weight loss and wasting in patients infected with human immunodeficiency virus. Clin Infect Dis 36, 6978.
20. Boffito, M, Acosta, E, Burger, D et al. (2005) Therapeutic drug monitoring and drug–drug interactions involving antiretroviral drugs. Antivir Ther 10, 469477.
21. Mshana, GH, Wamoyi, J, Busza, J et al. (2006) Barriers to accessing antiretroviral therapy in Kisesa, Tanzania: a qualitative study of early rural referrals to the national program. AIDS Patient Care STDS 20, 649657.
22. Tuller, DM, Bangsberg, DR, Senkungu, J et al. (2010) Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study. AIDS Behav 14, 778784.
23. Au, JT, Kayitenkore, K, Shutes, E et al. (2006) Access to adequate nutrition is a major potential obstacle to antiretroviral adherence among HIV-infected individuals in Rwanda. AIDS 20, 21162118.
24. Sanjobo, N, Frich, JC & Fretheim, A (2008) Barriers and facilitators to patients’ adherence to antiretroviral treatment in Zambia: a qualitative study. SAHARA J 5, 136143.
25. Weiser, SD, Fernandes, K, Anema, A et al. (2009) Food insecurity as a barrier to antiretroviral therapy (ART) adherence among HIV-infected individuals. Presented at 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, Cape Town, South Africa, 19–22 July 2009.
26. Normén, L, Chan, K, Braitstein, P et al. (2005) Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. J Nutr 135, 820825.
27. Weiser, SD, Frongillo, EA, Ragland, K et al. (2008) Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med 24, 1420.
28. Weiser, SD, Bangsberg, DR, Kegeles, S et al. (2009) Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behav 13, 841848.
29. Weiser, SD, Fernandes, F, Brandson, EK et al. (2009) The impact of food insecurity and body mass index on mortality among HIV-infected individuals first initiating HAART. J Acquir Immune Defic Syndr 52, 342349.
30. Stringer, JS, Zulu, I, Levy, J et al. (2006) Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA 296, 782793.
31. Zachariah, R, Fitzgerald, M, Massaquoi, M et al. (2006) Risk factors for high early mortality in patients on antiretroviral treatment in a rural district of Malawi. AIDS 20, 23552360.
32. Johannessen, A, Naman, E, Ngowi, BJ et al. (2008) Predictors of mortality in HIV-infected patients starting antiretroviral therapy in a rural hospital in Tanzania. BMC Infect Dis 8, 52.
33. President's Emergency Plan for AIDS Relief (2009) PEPFAR policy change in food and nutrition programming. http://www.pepfar.gov/guidance/98836.htm (accessed July 2011).
34. President's Emergency Plan for AIDS Relief (2010) Country operational plan (COP) guidance: fiscal year 2011. http://www.pepfar.gov/documents/organization/148826.pdf (accessed July 2011).
35. World Health Organization (2003) Nutrient requirements for people living with HIV/AIDS. Report of a technical consultation. http://www.who.int/nutrition/publications/Content_nutrient_requirements.pdf (accessed July 2011).
36. Food and Nutrition Technical Assistance (2004) HIV/AIDS: a guide for nutritional care and support. http://www.fantaproject.org/publications/HIVguide.shtml (accessed June 2009).
37. Lachin, JM (2000) Biostatistical Methods: The Assessment of Relative Risks. New York: John Wiley Publishing.
38. Hosmer, D Jr & Lemeshow, S (2000) Applied Logistic Regression, 2nd ed. New York: John Wiley Publishing.
39. World Health Organization (2004) Nutrition counseling, care and support for HIV-infected women: guidelines on HIV-related care, treatment and support for HIV-infected women and their children in resource constrained settings. http://www.who.int/hiv/pub/prev_care/nutrition/en/index.html (accessed June 2009).
40. Médecins Sans Frontières (2003) Emergency Nutrition Guidelines: Handbook for Field Managers and Clinicians. Geneva: Médecins Sans Frontières.
41. Filteau, S (2009) The HIV-exposed, uninfected African child. Trop Med Int Health 14, 276287.
42. Piwoz, EG, Humphrey, JH, Tavengwa, NV et al. (2007) The impact of safer breastfeeding practices on postnatal HIV-1 transmission in Zimbabwe. Am J Public Health 97, 12491254.
43. Tabi, M & Vogel, RL (2006) Nutritional counselling: an intervention for HIV-positive patients. J Adv Nurs 54, 676682.
44. Fadnes, LT, Engebretsen, IM, Wamani, H et al. (2009) Need to optimise infant feeding counselling: a cross-sectional survey among HIV-positive mothers in Eastern Uganda. BMC Pediatr 9, 2.
45. DePee, S & Semba, RD (2010) Role of nutrition in HIV infection: review of evidence for more effective programming in resource-limited settings. Food Nutr Bull 31, Suppl. 4, S313S344.
46. Burbano, X, Miguez-Burbano, MJ, McCollister, K et al. (2002) Impact of a selenium chemoprevention clinical trial on hospital admissions of HIV-infected participants. HIV Clin Trials 3, 483491.
47. Kaiser, JD, Campa, AM, Ondercin, JP et al. (2006) Micronutrient supplementation increases CD4 count in HIV-infected individuals on highly active antiretroviral therapy: a prospective, double-blinded, placebo-controlled trial. J Acquir Immune Defic Syndr 42, 523528.
48. Irlam, JH, Visser, MME, Rollins, N et al. (2010) Micronutrient supplementation in children and adults with HIV infection. Cochrane Database Syst Rev issue 12, CD003650.
49. Drain, PK, Kupka, R, Mugusi, F et al. (2007) Micronutrients in HIV-positive persons receiving highly active antiretroviral therapy. Am J Clin Nutr 85, 333345.
50. Koethe, JR, Chi, BH, Megazzini, KM et al. (2009) Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings. Clin Infect Dis 49, 787798.
51. Rosen, S, Fox, MP & Gill, CJ (2007) Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PloS Med 4, e298.
52. Brinkhof, MW, Dabis, F, Myer, L et al. (2008) Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bull World Health Organ 86, 559567.
53. Byron, E, Gillespie, S & Nangami, M (2008) Integrating nutrition security with treatment of people living with HIV: lessons from Kenya. Food Nutr Bull 29, 8797.
54. Cantrell, RA, Sinkala, M, Megazinni, K et al. (2008) A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr 49, 190195.
55. Nash, D, Korves, C, Saito, S et al. (2008) Characteristics of facilities and programs delivering HIV care and treatment services are associated with loss to follow-up rates in programs from 8 sub-Saharan African countries (abstract no. 838). Presented at 15th Conference on Retroviruses and Opportunistic Infections (CROI 2008), Boston, MA, 3–6 February 2008.
56. Chilenje Infant Growth Nutrition and Infection Study Team (2010) Micronutrient fortification to improve growth and health of maternally HIV-unexposed and exposed Zambian infants: a randomised controlled trial. PloS One 5, e11165.
57. Mapunjo, S & Urassa, DP (2007) Quality standards in provision of facility based HIV care and treatment: a case study from Dar es Salaam Region, Tanzania. East Afr J Public Health 4, 1218.
58. Briend, A, Prudhon, C, Prinzo, ZW et al. (2006) Putting the management of severe malnutrition back on the international health agenda. Food Nut Bull 27, Suppl. 3, S3S6.
59. Bahwere, P, Sadler, K & Collins, S (2009) Acceptibility and effectiveness of chickpea sesame-based ready-to-use therapeutic food in malnourished HIV positive adults. Patient Prefer Adherence 3, 6775.
60. Ndekha, MJ, Manary, MJ, Ashorn, P et al. (2005) Home-based therapy with ready-to-use therapeutic food is of benefit to malnourished, HIV-infected Malawian children. Acta Paediatr 94, 222225.
61. World Health Organization (2009) Towards Universal Access: Scaling up Priority HIV/AIDS Interventions in the Health Sector: Progress Report. Geneva: WHO; available at http://www.data.unaids.org/pub/Report/2009/20090930_tuapr_2009_en.pdf
62. King, G, Rosen, O & Tanner, MA (2004) Ecological Inference: New Methodological Strategies. New York: Cambridge University Press.
63. World Health Organization (2004) National AIDS Programmes: A guide to Monitoring and Evaluating HIV/AIDS Care And Support. Geneva: WHO; available at http://www.data.unaids.org/publications/irc-pub06/jc1013-caresupport_en.pdf
64. United Nations General Assembly Special Session on HIV/AIDS (2009) Monitoring the Declaration of Commitment on HIV/AIDS: Guidelines on the Construction of Core Indicators. 2010 Reporting. Geneva: WHO; available at http://www.data.unaids.org/pub/manual/2009/jc1676_core_indicators_2009_en.pdf

Keywords

Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries

  • Aranka Anema (a1) (a2), Wendy Zhang (a1), Yingfeng Wu (a3), Batya Elul (a3) (a4), Sheri D Weiser (a5), Robert S Hogg (a1) (a6), Julio SG Montaner (a1) (a2), Wafaa El Sadr (a3) (a4) and Denis Nash (a3) (a4)...

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