scholarly journals Relapse of undernutrition and food insecurity in a nutritional program in HIV care: mixed-methods study in Tigray region, Ethiopia.

2020 ◽  
Author(s):  
Fisaha Tesfay ◽  
Anna Ziersch ◽  
Sara Javanparast ◽  
Lillian Mwanri
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Nutritional Status ◽  
Food Insecurity ◽  
Functional Status ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Tigray Region ◽  
Nutritional Recovery ◽  
Living With Hiv

Abstract Background Food insecurity is one of the major contributors to poor attainment of nutritional recovery among people living with HIV who are enrolled in nutritional programs. Nevertheless, nutritional programs in HIV care settings implemented in many countries are not designed to address food insecurity. This study in Tigray region Ethiopia examined relapse of undernutrition, and in particular how food insecurity had an impact on effectiveness of the nutritional program, specifically relapse of undernutrition after nutritional recovery Methods This study employed mixed-methods approach involving quantitative and qualitative methods. In the quantitative part, hospital records were collected of 1757 adults and 236 children living with HIV who were enrolled in the nutritional program. Logistic and cox-regression analysis were used to analyse the data. In the qualitative study, data was collected through in-depth interviews with 20 adults, 15 caregivers of children living with HIV, and 13 health providers and program managers. Thematic framework analysis was used to analyse the qualitative data. Results Among those who graduated from the nutritional program, 18% of adults and 7% of children relapsed. Lower educational status (primary and secondary), no membership of a community HIV support group, ambulatory and bedridden functional status, longer periods on ART (more than 24 months), presence of an opportunistic infection and poor baseline nutritional status were associated with relapse. Furthermore, those from rural areas, who did not attend formal education, were employed and had bedridden functional status, anaemia and worst nutritional status were likely to have more frequent episodes of relapse than their counterparts. Findings of the qualitative study also highlighted that poverty, poor livelihood, and food insecurity were the fundamental challenges to the effectiveness of nutritional programs in HIV care including relapse. Household food insecurity contributed to the selling and sharing of the nutritional supports and negatively impacted program effectiveness by contributing to relapse of undernutrition. Conclusions Unless nutritional programs take into consideration the underlying determinants of food insecurity in the design, implementation, and funding of nutritional programs in HIV care, the success of the nutritional programs like those implemented in Ethiopia will be undermined.

scholarly journals Relapse of undernutrition and food insecurity in a nutritional program in HIV care: mixed-methods study in Tigray region, Ethiopia.

2020 ◽  
Author(s):  
Fisaha Haile Tesfay ◽  
Anna Ziersch ◽  
Sara Javanparast ◽  
Lillian Mwanri
Keyword(s):  
Mixed Methods ◽  
Qualitative Study ◽  
Nutritional Status ◽  
Food Insecurity ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Tigray Region ◽  
Nutritional Recovery ◽  
Time To Relapse ◽  
Living With Hiv

Abstract Introduction Food insecurity is one of the major contributors to poor attainment of nutritional recovery among people living with HIV who are enrolled in nutritional programs. Food insecurity also significantly contributes to high rates of relapse after nutritional recovery among the beneficiaries nutritional programs. Nevertheless, nutritional programs in HIV care settings implemented in many countries are not designed to address food insecurity. This study examined a nutritional program delivered in HIV care settings in the Tigray region, Ethiopia. It explored the factors that contributed to relapse of undernutrition, and in particular how food insecurity had an impact on effectiveness of the nutritional program, specifically relapse of undernutrition after nutritional recovery. Methodology This study employed mixed-methods approach involving quantitative and qualitative methods. In the quantitative part, hospital records were collected of 1757 adults and 236 children people living with HIV who were enrolled in the nutritional program. Logistic and cox-regression analysis were used to examine the frequency and determinants of relapse of undernutrition. In the qualitative study, data was collected through in-depth interviews with 20 adults, 15 caregivers of children living with HIV, and 13 health providers and program managers. Thematic framework analysis was used to analyse the qualitative data. Results Among those who graduated from the nutritional program, 18% of adults and 7% of children relapsed to undernutrition. The mean time to relapse for adults was 68.5 months (95% CI, 67.0–69.9). It was not possible to calculate the average time to relapse in children because of the small sample size. Lower educational status (primary and secondary), no membership of a community HIV support group, ambulatory and bedridden functional status, longer periods on ART (more than 24 months), presence of an opportunistic infection and poor baseline nutritional status were associated with relapse of undernutrition. Furthermore, those from rural areas, who did not attend formal education, were employed, and had bedridden functional status, anemia and worst nutritional status were likely to have more frequent episodes of relapse than their counterparts. Findings of the qualitative study also highlighted that poverty, poor livelihood, and food insecurity were the fundamental challenges to the effectiveness of nutritional programs in HIV care. Household food insecurity contributed to the selling and sharing of the nutritional supports and negatively impacted the program effectiveness, delaying nutritional recovery and contributing to relapse of undernutrition. Conclusion and recommendation Unless nutritional programs take into consideration the underlying determinants of food insecurity in the design, implementation, and funding of nutritional programs in HIV care, the success of the nutritional programs like those implemented in Ethiopia will be undermined and the vicious cycle of undernutrition amongst people living with HIV will continue.

scholarly journals Relapse into Undernutrition in a Nutritional Program in HIV Care and the Impact of Food Insecurity: A Mixed-Methods Study in Tigray Region, Ethiopia

2021 ◽  
Vol 18 (2) ◽  
pp. 732
Author(s):  
Fisaha Haile Tesfay ◽  
Anna Ziersch ◽  
Sara Javanparast ◽  
Lillian Mwanri
Keyword(s):  
Mixed Methods ◽  
Food Insecurity ◽  
Hiv Care ◽  
Considerable Proportion ◽  
People Living With Hiv ◽  
Design Strategies ◽  
Tigray Region ◽  
Nutritional Recovery ◽  
Adults And Children ◽  
The Impact

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.

scholarly journals Evaluation of routine Isoniazid Preventive Therapy among People Living with HIV for reducing Tuberculosis; a retrospective cohort study in Tanzania (2012-2016)

2020 ◽  
Author(s):  
Werner Maokola ◽  
Bernard Ngowi ◽  
Lovett Lawson ◽  
Michael Mahande ◽  
Jim Todd ◽  
...  
Keyword(s):  
Cohort Study ◽  
Functional Status ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Scale Up ◽  
Preventive Therapy ◽  
Isoniazid Preventive Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Living With Hiv

Abstract Background: Isoniazid Preventive Therapy (IPT) reduced Tuberculosis (TB) among People Living with HIV (PLHIV). Despite this, uptake has been reported to be sub-optimal . We describe characteristics of visits in which PLHIV were screened TB negative (as the main source for IPT initiation), determine characteristics of visits in which PLHIV were initiated on IPT as well as determined factors associated with IPT initiation to inform program scale up and improve quality of service.Methods : Retrospective cohort study design which involved PLHIV enrolled into care and treatment clinics in Dar es Salaam, Iringa and Njombe regions from January 2012 to December 2016. The study aimed at evaluating implementation of IPT among PLHIV. Data analysis was conducted using STATA.Results: A total 173,746 were enrolled in CTC in the 3 regions during the period of follow up and made a total of 2,638,876 visits. Of the eligible visits, only 24,429 (1.26%) were initiated on IPT. In multivariate analysis, 50 years and more (aOR=3.42, 95% CI: 3.07-3.82, P<0.01), bedridden functional status individuals with bedridden functional status (aOR=4.56, 95% CI:2.45-8.49, P<0.01) and WHO clinical stage II had higher odds of IPT initiation (aOR=1.18, 95% CI:1.13-1.23, P<0.01). Furthermore, enrolment in 2016 (aOR=2.92, 95% CI:2.79-3.06, P<0.01), enrolment in hospitals (aOR=1.84, 95% CI:1.77-1.90, P<0.01), enrolment in public health facilities (aOR=1.82, 95% CI: 1.75-1.90, P<0.01) and been on care for more than one year (aOR=6.77, 95% CI: 5.25-8.73, P<0.000) were also more likely to be initiated on IPT. Enrollment in Iringa (aOR=0.44, 95% CI: 0.41-0.47, P<0.01) and good adherence (aOR=0.56, 95% CI 0.47-0.67, P<0.01) was less likely to be initiated on IPT.Conclusions: Our study documented low IPT initiation proportion among those who were enrolled in HIV care and eligible in the 3 regions during the study period. Variations in IPT initiation among regions signals different dynamics affecting IPT uptake in different regions and hence customized approaches in quality improvement. Implementation research is needed to understand health system as well as cultural barriers in the uptake of IPT intervention.

scholarly journals 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 ◽  
Vol 12 (1) ◽  
pp. e047205
Author(s):  
Fisaha Haile Tesfay ◽  
Sara Javanparast ◽  
Hailay Gesesew ◽  
Lillian Mwanri ◽  
Anna Ziersch
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Nutritional Recovery ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Nutritional Outcomes

ObjectivesAlthough 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.DesignSystematic review.Data sourcesWe 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 criteriaStudies 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 synthesisData 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.ResultsSixteen 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 recommendationsNutritional 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 numberCRD42020196827.

Gender-affirming healthcare experiences and medical transition among transgender women living with HIV: a mixed-methods study

Sexual Health ◽  
2019 ◽  
Vol 16 (4) ◽  
pp. 367 ◽  
Author(s):  
Ashley Lacombe-Duncan ◽  
Peter A. Newman ◽  
Greta R. Bauer ◽  
Carmen H. Logie ◽  
Yasmeen Persad ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Study ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Providers ◽  
Structural Barriers ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Trans Women ◽  
Living With Hiv

Background Transgender (trans) women are overrepresented among people living with HIV, yet trans women living with HIV (WLWH) experience lower access to HIV care. Access to medical transition may facilitate access to HIV care among trans WLWH. This study sought to describe barriers and facilitators to access to medical transition among trans WLWH. Methods: This convergent parallel mixed-methods study drew on cross-sectional quantitative data from 48 trans WLWH analysed using descriptive and bivariate analyses, as well as qualitative semistructured interview data from a subsample of 11 participants analysed using framework analysis. The primary outcome was self-reported transition experience (completed or in the process of medical transition vs planning to but have not begun medical transition). Quantitative and qualitative results were merged and analysed for convergence, divergence and/or expansion of understanding. Results: Just over half the participants reported being fully completed medical transition or in the process of medical transition (52.1% (25/48); 95% confidence interval (CI) 37.5–67.6%), with one-fifth reporting planning to but not having begun medical transition (18.8% (9/48); 95% CI 8.3–29.2%). Factors significantly associated with not having begun one’s medical transition included housing instability, transphobia, HIV-related stigma and barriers in access to care. Qualitative findings revealed varied transition experiences, influenced by community norms, passing and class privilege, HIV and structural barriers. Mixed-methods results showed positive relationships between trans WLWH and HIV care providers in terms of trans and HIV health care. Conclusions: HIV-related stigma and social determinants of health limit access to medical transition for trans WLWH. Stigma must be addressed in a broad range of healthcare settings, in addition to structural barriers, to increase access to gender-affirming HIV care and medical transition for trans WLWH.

scholarly journals Experience of nutritional counselling in a nutritional programme in HIV care in the Tigray region of Ethiopia using the socio-ecological model

2021 ◽  
Vol 40 (1) ◽  
Author(s):  
Fisaha Haile Tesfay ◽  
Anna Ziersch ◽  
Lillian Mwanri ◽  
Sara Javanparast
Keyword(s):  
Data Analysis ◽  
Ecological Model ◽  
Well Being ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Health Providers ◽  
Holistic View ◽  
Nutritional Counselling ◽  
Tigray Region ◽  
Living With Hiv

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.

scholarly journals FRAILTY, FOOD INSECURITY, AND NUTRITIONAL STATUS IN PEOPLE LIVING WITH HIV

2015 ◽  
pp. 1-7
Author(s):  
E. SMIT ◽  
C. WANKE ◽  
K. DONG ◽  
A. GROTHEER ◽  
S. HANSEN ◽  
...  
Keyword(s):  
Weight Loss ◽  
Nutritional Status ◽  
Activities Of Daily Living ◽  
Food Insecurity ◽  
Daily Living ◽  
Average Weight ◽  
People Living With Hiv ◽  
Unintentional Weight Loss ◽  
Average Weight Loss ◽  
Living With Hiv

Background: Nutritional status and food insecurity are associated with frailty in the general U.S. population, yet little is known about this in the aging population of people living with HIV (PLWH). Objectives: Given the potential importance of nutrition and the amenability to intervention, we examined the association between nutritional status, food insecurity, and frailty in PLWH. Design: Cross sectional study. Setting: Boston, Massachusetts, U.S.A. Participants: 50 PLWH, age ≥45 years, recruited from a cohort study examining risk factors for cardiovascular disease. Measurements: Frailty, duration of HIV, use of antiretroviral therapy, disease history, food insecurity, physical function, and physical activity were assessed by questionnaire. Dietary intake was assessed using 3-day food records. Blood was drawn for CD4+ cell count, hemoglobin, hematocrit, and lipid levels. Physical measurements included height, weight, and skinfold thickness. Results: The prevalence of frailty was 16% (n=8), 44% were pre-frail (n=22) and 40% were not frail (n=20). The number of reported difficulties with 20 activities of daily living was highest in frail (mean 10.4±3.9 SD), followed by pre-frail (6.5±4.6), and lowest in not frail participants (2.0±2.3). Seven (88%) of the frail PLWH lost weight with an average weight loss of 22.9 pounds; 6 (75%) reported unintentional weight loss, and all 6 of these met the frailty criteria for weight loss of 10 or more pounds. Nine (45%) of the not frail PLWH reported losing weight with an average weight loss of 6.2 pounds; 5 (23%) reported unintentional weight loss of <10 pounds. Frail PLWH were more likely to report being food insecure than not frail PLWH (63% vs. 10%, p=0.02), and tended to have lower energy intake than not frail PLWH. Conclusion: Research is needed on targeted interventions to improve food security and activities of daily living in PLWH for both the prevention and improvement of frailty.

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