Use, perceptions, and acceptability of a ready-to-use supplementary food among adult HIV patients initiating antiretroviral treatment: a qualitative study in Ethiopia

Abstract

ObjectivesReady-to-use supplementary foods (RUSF) are used increasingly in human immunodeficiency virus (HIV) programs, but little is known about how it is used and viewed by patients. We used qualitative methods to explore the use, perceptions, and acceptability of RUSF among adult HIV patients in Jimma, Ethiopia.MethodsThe study obtained data from direct observations and 24 in-depth interviews with HIV patients receiving RUSF.ResultsParticipants were generally very motivated to take RUSF and viewed it as beneficial. RUSF was described as a means to fill a nutritional gap, to “rebuild the body,” and protect it from harmful effects of antiretroviral treatment (ART). Many experienced nausea and vomiting when starting the supplement. This caused some to stop supplementation, but the majority adapted to RUSF. The supplement was eaten separately from meal situations and only had a little influence on household food practices. RUSF was described as food with “medicinal qualities,” which meant that many social and religious conventions related to food did not apply to it. The main concerns about RUSF related to the risk of HIV disclosure and its social consequences.ConclusionHIV patients view RUSF in a context of competing livelihood needs. RUSF intake was motivated by a strong wish to get well, while the risk of HIV disclosure caused concerns. Despite the motivation for improving health, the preservation of social networks was prioritized, and nondisclosure was often a necessary strategy. Food sharing and religious fasting practices were not barriers to the acceptability of RUSF. This study highlights the importance of ensuring that supplementation strategies, like other HIV services, are compatible with the sociocultural context of patients.

“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

“…A less sweet-tasting formulation should likely be considered for future uses. LNS was experienced as stigmatizing by only 3 of our study participants; the stigmatizing connotations of LNS were also observed, but not quantified, in Kenya [41] and Ethiopia [46]. Our participants’ (mis)perceptions of LNS as a drug or medicine occurred less frequently than in the Kenyan and Ethiopian studies [41,46].…”

“…Sharing of LNS has also been reported in studies in Ethiopia [46] and Malawi [43]. Wherever food sharing is a common practice and even a cultural expectation, as it is in much of sub-Saharan Africa, it is often difficult for participants to not share their supplement, especially with their children.…”

“…In Malawi, 92.4% of participants reported consuming the recommended amount (140 g) the day prior to clinical visit [26], while in Ethiopia, 74% reported eating the recommended portion (200g LNS+30g whey or soy protein) in the prior three days [46]. In Kenya, participants in a cross-over randomized control trial ate more than 75% of the daily dosage of peanut-based LNS (250g) on 87.7% of days under direct observation (compared to 86.1% of days for a soy maize blend) [42].…”

“…For example, pregnant and lactating women of unknown HIV status in Ghana [17] and HIV-infected adults in Ethiopia [46] initially reported the sweetness of LNS to cause nausea and vomiting. A less sweet-tasting formulation should likely be considered for future uses.…”

Preferences for food and nutritional supplements among adult people living with HIV in Malawi

“…RUTF shows promising results in achieving a more prompt restoration of BMI (14,27) and fatfree mass (27) , and is increasingly being used in nutrition supplementation programmes (18) . However, increasing evidence shows that the acceptance of RUTF is low among adult PLHIV (14,17) .…”