Improving Food Security and Nutrition to Promote ART Adherence in Latin America

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DESCRIPTION (provided by applicant): Latin America and the Caribbean (LAC) is the second most affected region in the world by HIV/AIDS. While access to HIV antiretroviral therapy (ART) has increased dramatically, raising expectations that universal access may soon be achieved in LAC, poor nutrition and food insecurity are often cited by patients, providers, and HIV treatment advocates as main obstacles to accessing and adhering to ART treatment. ART requires regular medical visits, which involve transport costs and lost work time, thereby reducing household monetary resources available for food acquisition. People who begin treatment but cannot follow food and nutrition recommendations are likely to have increased drug side effects that create significant discomfort or even inhibit eating, which may lead to treatment interruptions or discontinuation. Poor adherence, in turn, leads to treatment failure and development and spread of drug resistance. Poor nutrition also affects the efficacy of drug metabolism. Therefore, promoting food security and effective nutritional support are crucial to ensuring optimal ART uptake, adherence, and outcomes. This study is proposed in partnership by the RAND Corporation, program staff from the United Nations World Food Program (WFP) in Latin America, and community partners in Honduras. The project will be conducted in two phases. Phase 1 involves qualitative, formative research methods to (1) gain understanding of availability and cost of the local foods and the regular diet, (2) evaluate the level of food security among people living with HIV, including intra-household food distribution patterns, and assess the nutritional status of HIV affected individuals, and (3) examine the role that food security and nutrition play in HIV treatment access, utilization and adherence. Phase 2 will develop and pilot-test a multi-component nutrition intervention through a randomized, controlled trial conducted at 4 HIV clinics in Honduras (two clinics randomly assigned to intervention and two clinics to comparison group). Patients at all sites will receive nutrition counseling, following the guidelines currently proposed by the World Health Organization as the standard of care for HIV-infected individuals. In addition, clients at the intervention sites will receive a multi-component nutrition intervention that includes food assistance and a multiple- micronutrient mix designed to cover the specific needs of HIV-affected individuals. As one of the first studies to systematically examine the role of food security, nutritional status, and a multi-component nutritional intervention on HIV treatment retention, utilization and adherence of HIV-infected individuals in resource limited settings, the proposed research has tremendous potential to inform larger evaluations of nutritional interventions, and more generally, food assistance programs in Latin America and other parts of the developing world for HIV-infected individuals. The purpose of this three-year study is to develop, implement, and pilot test a culturally appropriate, multi- component food and nutrition intervention that will enhance treatment adherence for people living with HIV and food insecurity in Honduras, which is among the Latin America nations with the highest HIV prevalence rates.