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

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.

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

“…The current study was part of a larger study that examined the determinants of nutritional outcomes and challenges of a nutritional programme in the Tigray region of Ethiopia, which has been described in detail elsewhere [ 37 , 38 ].…”

“…The model identifies that there are individual, interindividual, institutional, community and social policy level factors that influence health outcomes and behaviours, and highlights the importance of considering the dynamics and interactions between these levels [ 33 ]. The SEM has been applied in studies involving nutritional programmes in HIV care, sexual and reproductive health amongst people living with HIV, adherence to ART and acceptability of infant feeding to prevent HIV [ 34 – 37 ].…”