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

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 (body mass index [BMI], CD4 count) were analyzed using factorial mixed-models that accounted for geographic clustering. Results: At 6 months, all groups improved CD4 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 plus nutrition and Asha-support support plus supplement interventions demonstrated independent significant improvements in CD4 count; the interaction term was significant (β=529.9; 95% confidence internal [CI]=512.0, 547.8; p=.006). BMI also increased for all groups: Asha only (D=0.95, SD=0.82), Asha plus nutrition education (D=1.28, SD=0.53), Asha plus nutrition supplement (D=2.38, SD=0.60), nutrition supplement and nutrition supplement and education (D=2.72=0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (β =.27, 95% CI=2.5, 2.7, p = 0.80). Conclusion: Interventions run by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.

Application of information-motivation-behavioral skills model in adherence to diet and reduction of depression among HIV-positive patients: health promotion strategy 90-90-90

“…Sanctions against Iran have put economic pressure on the people, espe cially HIV patients, and have weakened the effectiveness of the IMB model, but in Ameri et al the IMB model was effective in adherence to the diet [22]. Similarly to our study, Nyamathi in India reported that food intake was challenging in HIV/AIDS patients, so that lack of resources, stigma, dis crimination, and poor behavior of food industry employees reduced food intake in patients [29].…”

“…In our study, sugar consumption was reduced in the in tervention group. In the same vein, Nyamathi et al [29] found that the intervention group followed a healthy diet after the intervention and decreased consumption of un healthy foods. In the present study, an educational training method was administered and the participants were provid ed with information about healthy food.…”

“…Our results also showed no differences between the two groups in terms of protein intake. In contrast, Nyamathi et al [29] conducted an educational intervention based on accredited social health activist (ASHA) behavioral support and found that the amount of received protein increased in the intervention group. In our intervention, HIV patients could not afford to purchase foods due to high sanctions and high prices of protein products.…”

Cervical cancer awareness and presence of abnormal cytology among HIV-infected women on antiretroviral therapy in rural Andhra Pradesh, India

“…23,24 The lower prevalence of ASCUS and LSIL observed in our population may be because our participants had completed six months of ART adherence and nutritional intervention at the time of cytology screening, resulting in significant improvement in CD4+ T cell counts. 17,28 Previous studies have shown a strong association between CD4+ T cell recovery and regression of ASCUS and LSIL. 29,30 While studies have shown that ART is also associated with reduced HSIL and SCC, 31,32 these outcomes develop over a longer period of time, and thus longer follow-up of patients may be needed to observe reductions in HSIL and SCC.…”

Association Between Maternal HIV Stigma Among South Indian Mothers Living with HIV and the CD4 Count of Children Living with HIV

“…This cross-sectional secondary analysis used data from a quasi-experimental trial funded by the National Institute of Mental Health (R01MH098728) that investigated the impact of a nurse-led ASHA (Accredited Social Health Activist)-supported behavioral and nutritional intervention among WLWH in rural Nellore and Prakasam, India between April 2014 and November 2016 [41,42]. Flyerbased recruitment was utilized to engage participants from 16 community health centers and primary health clinics.…”