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|Title: ||Impact of Food and Nutrition Security on Adherence to Anti-Retroviral Therapy (ART) and Treatment Outcomes among Adult PLWHA in DireDawa Provisional Administration|
|Authors: ||Abiy, Seifu|
|Advisors: ||Dr. Fikru Tesfaye,Dr. Solomon Shiferaw|
|Copyright: ||2007 |
|Date Added: ||22-Apr-2008 |
|Publisher: ||Addis Ababa University|
Background: Adherence to Anti-Retroviral Therapy (ART) is critical for optimal
virologic suppression and improved CD4+ cell count that in turn determines the survival
of People Living with HIV/AIDS (PLWHA) on ART. So far a range of predictors of
adherence to ART in many different social and cultural settings have been identified.
However, household food and nutrition security as predictor of adherence to ART is less
Objective: The main objective of this research project is to assess the effect of household
food and nutrition security on adherence to ART and treatment outcomes.
Method: A cross-sectional study was conducted to assess the effect of household food
and nutrition security on adherence to ART and treatment outcomes. Both quantitative
and qualitative research methods were applied to triangulate the findings of one with
another. Adult PLWHA on ART for at least 3 months were the study participants.
Availability of enough food/money to buy one, behavioral and subjective questions, meal
frequency, dietary diversity, food aid and BMI were used as indicators to measure the
household food and nutrition security situation of PLWHA and self-reported adherence
as an indicator to measure adherence to ART. Change in CD4+ cell count, body weight,
functional status and frequency of opportunistic infections were used to measure
Result: Based on food security assessment core module close to 90% of PLWHA on
ART in Dire Dawa were food insecure and 30.1% had at least mild malnutrition. On
patient self report of adherence 96.6% of them were adherent to 95% of the ART drugs
prescribed. The median change in CD4 count after 6 months and the median change in
weight after 3 months of ART were 116 (IQR 82-182) and 3kg (IQR 1-6kg) respectively.
Reported diarrhea and lung disease among the study participants were 17.9% and 54.1%
respectively. Food and nutrition security indicators were associated with treatment outcomes. Food aid contributed to functional improvement (OR 1.89, 95% CI 1.20-2.97).
Dietary diversity and meal frequency were significantly positively correlated with change
in weight and change in CD4 count respectively (p<0.05). Pre-ART nutritional status was
significantly negatively correlated with change in weight after 3 months of ART
Discussion: Food and nutrition insecurity is a serious problem of PLWHA on ART.
Overcoming all the odds to adhere to the treatment PLWHA in the present study were
adherent to ART more than any documented adherence findings. But food and nutrition
insecurity was silent factor that impede treatment outcomes. Food aid, dietary diversity
and meal frequency were positively associated with functional improvement, weight gain
and CD4 increase. Pre-ART nutritional status was negatively correlated with weight gain
indicating better improvement among severely malnourished. Current malnutrition was
significantly associated with reported opportunistic infections.
Conclusion and recommendations: The mere success in achieving high level of
adherence among PLWHA taking ART should not undermine the impact of food and
nutrition security on the treatment outcomes which is the ultimate goal of the program.
Lack of food to take with medication is the main reason for those few non-adherents and
food ration improved functional status of PLWHA on ART. Food aid as relief together
with a sustainable income generating activities need to be included in ART program.|
|Description: ||A thesis Submitted to the School of Graduate Studies of Addis Ababa
University in partial fulfillment of the requirements for the Degree of
Masters of Public Health|
|Appears in:||Thesis - Public Health|
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