Nutrition Assessment, Counseling, and Support Interventions to Improve Health-Related Outcomes in People Living With HIV/AIDS

Abstract

Background While numerous studies have shown that severe to moderate wasting at the time of antiretroviral therapy (ART) initiation is strongly predictive of mortality, it remains unclear whether nutritional interventions at or prior to ART initiation will improve outcomes. This review examines data on nutrition assessment, counseling, and support (NACS) interventions in resource-limited settings. Methods We identified articles published between 2005 and 2014 on the effectiveness of NACS interventions, particularly its impact on five outcomes: mortality, morbidity, retention in care, quality of life, and/or prevention of ongoing HIV transmission. We rated the overall quality of individual articles and summarized the body of evidence and expected impact for each outcome. Results Twenty-one articles met all inclusion criteria. The overall quality of evidence was weak, predominantly due to few studies being designed to directly address the question of interest. Only two studies were randomized trials with proper control groups. The remainder were randomized studies of one type of food support versus another, cohort (non-randomized) studies, or single-arm studies. Ratings of individual study quality ranged from “medium” to “weak,” and the quality of the overall body of evidence ranged from “fair” to “poor.” We rated the expected impact on all outcomes as “uncertain.” Conclusion Rigorous, better designed studies in resource-limited settings are urgently needed to understand the effectiveness of nutrition assessment and counseling alone, as well as studies to understand better modalities of food support (targeting, timing, composition, form, and duration) to improve both short- and long-term patient retention in care and treatment, and clinical outcomes.

Experience of Nutritional Counselling in a Nutritional Program in HIV Care in the Tigray Region of Ethiopia Using the Socio-ecological Model

“…Research has indicated that locally and culturally sound nutritional counselling is vital to enhance and maintain the nutritional status of people living with HIV [42][43][44]. Engaging with participants and empowering them to take control of their nutrition and health is the fundamental principle of successful nutritional counselling in HIV care settings [14]. Evidence from other studies suggests that standard nutritional counselling should empower individuals with essential nutritional knowledge and assist them to understand the importance of nutrition to make informed decisions regarding their nutritional options [19,20].…”

“…To address HIV-related undernutrition and to improve HIV care outcomes, nutritional programs have been incorporated into HIV care services in many countries, particularly in sub-Saharan Africa [11][12][13][14].…”

A multinational qualitative investigation of the perspectives and drivers of exercise and dietary behaviors in people living with HIV

“…Our data demonstrate that for some patients, HIV has become the central or perhaps the only health issue that they felt needed regular management. Exercise does not directly influence immunological or virological outcomes in PLWH (O’Brien, Tynan, Nixon, & Glazier, 2016) and the role of diet on these outcomes is mixed (Tang, Quick, Chung, & Wanke, 2015). Furthermore, our data suggest that some PLWH prioritize behaviors that improve HIV-specific outcomes.…”

Validation of a counseling guide for adherence to antiretroviral therapy using implementation science

“…However, it is often difficult to maintain an adherent behavior for a long time. Counseling is a strategy applied in different contexts and environments to empower the patient into making decisions that contribute to improve, maintain and help him care for his health (13)(14) ;…”