Nutrition support for HIV-TB co-infected adults in Senegal, West Africa: A randomized pilot implementation study

Abstract

Background Food insecurity can contribute to poor adherence to both tuberculosis treatment and HIV antiretroviral therapy (ART). Interventions that target food insecurity have the potential to increase treatment adherence, improve clinical outcomes, and decrease mortality. The goals of this study were to compare the feasibility, acceptability, and potential impact of implementing two different forms of nutrition support for HIV-TB co-infected adults in the Casamance region of Senegal. Methods We conducted a randomized pilot implementation study among HIV-TB co-infected adults initiating treatment for TB (ClinicalTrials.gov Identifier: NCT03711721). Subjects received nutrition support in the form of a local food basket or Ready-to-Use Therapeutic Food (RUTF), distributed on a monthly basis for six months. Results A total of 178 monthly study encounters were completed by 26 HIV-TB co-infected adults; 14 received food baskets and 12 received RUTF. For both the food basket and RUTF, 100% of subjects obtained the supplement at every study encounter, transferred the supplement from the clinic to their household, and consumed the supplement. The food basket had greater acceptability and was more likely to be shared with members of the household. Adherence to TB treatment and ART exceeded 95%, and all outcomes, including CD4 cell count, hemoglobin, nutritional status, and food security, improved over the study period. All subjects completed TB treatment and were smear negative at treatment completion. The total cost of the local food basket was approximately $0.68 per day versus $0.99 for the RUTF. Conclusion The implementation of nutrition support for HIV-TB co-infected adults in Senegal is feasible and may provide an effective strategy to improve adherence, treatment completion, and clinical outcomes for less than 1 USD per day. Further studies to determine the impact of nutrition support among a larger population of HIV-TB co-infected individuals are indicated.

Food for thought: addressing undernutrition to end tuberculosis

“…In Senegal, PLWTB who received deliveries of food baskets and ready-to-use therapeutic foods which cost less than a dollar a day achieved 95% adherence to both antiretroviral and antimycobacterial therapy as well as reduction in food insecurity and improvement in nutritional status. 45 In India, PLWTB who received nutritional supplementation that cost $10 per month were less likely to disengage with care than those who did not receive supplementation. Only one person (1%) was lost to follow up in the supplementation arm as compared to 41 individuals (10%) in the no supplementation arm.…”

Acceptability and Adherence to Peanut-Based Energy-Dense Nutritional Supplement Among Adult Malnourished Pulmonary Tuberculosis Patients in Ballabgarh Block of Haryana, India

“…A study among HIV-TB coinfected patients in Senegal reported that 41.6% of the participants felt that the taste could be improved; 16.6% felt it was too salty, 16.6% felt it was both too salty and too sweet, while 8.3% felt it was too sweet. 4 The adherence to peanut-based EDNS in this study was 100%. However, the study was constrained by very low sample size.…”

“…Studies have shown that incentives such as nutritional supplementation increases adherence to the antituberculosis treatment, 4,15 and this strategy can be used to decrease default rates and improve adherence in our settings. India has set a target to eliminate tuberculosis by the year 2025.…”

“…3 Nutritional supplementation has also been shown to improve the treatment adherence among tuberculosis patients. 4 Recognizing the role of nutritional therapy in management of tuberculosis, the Government of India has instituted a direct cash transfer of INR 500 (approximately US$7) every month to patients with tuberculosis for nutritional support. However, in an overall environment of food insecurity and poverty in the household, cash provided may not be sufficient to support the nutritional requirements in addition to the implementation challenges.…”

“…Studies among adult patients in Senegal and Vietnam found variable acceptability but high adherence of peanut-based EDNS. 4,10 As a precursor to the trial on effectiveness of EDNS in improving treatment outcomes, we conducted a study to assess the acceptability and adherence to EDNS providing about 1000 kcal along with necessary micro and macronutrients, among adult malnourished pulmonary tuberculosis patients in Ballabgarh block of district Faridabad, Haryana, India.…”