Improving ART Adherence Through Urban Gardening and Peer Nutritional Counseling in the Dominican Republic

近年来，在拉丁美洲和加勒比地区，艾滋病毒抗逆转录病毒疗法的获得率急剧增加， 加勒比地区（LAC），特别是多米尼加共和国（DR）;然而，粮食不安全和贫困 营养已成为艾滋病毒感染者利用和坚持抗逆转录病毒疗法的障碍， 尤其是在资源匮乏的环境中。我们在DR的试点工作发现，68%的艾滋病毒感染者报告中度或 严重的粮食不安全。大多数方案旨在解决资源匮乏地区艾滋病毒感染者的粮食不安全问题， 环境涉及提供食物补充，取得了积极成果;然而，这种努力通常 不可持续。此外，大多数干预措施主要侧重于体重过轻而超重的艾滋病毒感染者， 和肥胖也是一个日益增长的问题。可持续的方法，增加获得食物的机会， 需要促进艾滋病毒感染者的均衡营养。城市园艺与同行营养 心理咨询是一种可能的解决办法。这项为期三年的研究旨在制定、实施和 评估文化上适当的多组成部分的可行性，可接受性和初步有效性 针对粮食不安全和营养健康的干预措施，最终目标是改善抗逆转录病毒疗法 本研究的具体目的是：（1）采用形成性研究， 饮食模式和当地可用的食物，以及我们对营养咨询的初步研究 和城市园艺，以制定多成分营养干预措施， 将文化上适当的、同伴主导的营养教育与可持续的城市花园相结合的艾滋病毒感染者 组成部分;（2）评估城市园艺加的可行性、可接受性和初步有效性 同伴营养咨询，以改善我们的主要成果（艾滋病毒护理保留，ART坚持， 病毒学抑制）在短期（6个月）和长期（12个月）;和（3）探索初步的 干预对潜在中介者（粮食安全、营养状况、内化的艾滋病毒污名和社会影响）的影响 支持），这是次要成果。这项拟议中的研究涉及来自以下国家的研究人员之间的伙伴关系： 兰德公司，加州大学弗朗西斯科分校（UCSF）和圣多明各自治大学， 其他当地合作伙伴，包括联合国世界粮食计划署（粮食计划署）的项目工作人员， 多米尼加农业部和多米尼加国家艾滋病毒/艾滋病理事会。它建立在我们以前的 在拉丁美洲和加勒比其他地方开展工作，并在兰德公司、世界粮食计划署和灾难恢复地区的当地合作伙伴之间建立关系 第一批研究之一，以制定一个可持续的粮食生产方法与同伴营养咨询， 主要产品将包括：1）易于使用的同伴营养咨询课程和城市花园 培训材料; 2）关于我们干预小学的可行性，可接受性和效果的试点数据 结果和潜在的调解人;和3）如果结果是有希望的，R 01申请进行全面的- 动力群集RCT，检查DR中大量诊所的效果。

In recent years, access to antiretroviral therapy (ART) for HIV has increased dramatically in Latin America and the Caribbean (LAC) and in particular in the Dominican Republic (DR); however, food insecurity and poor nutrition have emerged as barriers to ART utilization and adherence among people living with HIV (PLHIV), especially in low-resource settings. Our pilot work in the DR found that 68% of PLHIV report moderate or severe food insecurity. Most programs aimed at addressing food insecurity among PLHIV in low-resource settings have involved providing food supplementation, with positive results; however, such efforts are typically not sustainable. Further, most interventions focus primarily on PLHIV who are underweight, while overweight and obesity are also a growing concern. Sustainable approaches that increase access to food and also promote balanced nutrition among PLHIV are needed. Urban gardening together with peer nutritional counseling represents a potential solution. The purpose of this three-year study is to develop, implement, and evaluate the feasibility, acceptability, and preliminary effectiveness of a culturally appropriate, multi-component intervention that targets food insecurity and nutritional health with the ultimate goal of improving ART adherence and virologic suppression for PLHIV in the DR. The specific aims are to: (1) Use formative research on dietary patterns and locally available foods, together with our preliminary research on nutritional counseling and urban gardening, to develop a multi-component nutrition intervention to address food insecurity among PLHIV that integrates culturally-appropriate, peer-led nutritional education with a sustainable urban garden component; (2) Evaluate the feasibility, acceptability and preliminary effectiveness of urban gardening plus peer nutritional counseling on improving our primary outcomes (HIV care retention, ART adherence, and virologic suppression) in both the short (month 6) and longer terms (month 12); and (3) Explore the preliminary intervention effects on potential mediators (food security, nutritional status, internalized HIV stigma, and social support), which are secondary outcomes. The proposed study involves a partnership among researchers from RAND, University of California San Francisco (UCSF) and the Universidad Autónoma de Santo Domingo and other local partners, including program staff from the United Nations World Food Program (WFP), the Dominican Ministry of Agriculture, and the Dominican National HIV/AIDS Council. It builds on our previous work elsewhere in LAC and established relationships between RAND, WFP, and local partners in the DR. As one of the first studies to develop a sustainable food production approach with peer nutrition counseling among PLHIV, key products will include: 1) an easy-to-use peer nutritional counseling curriculum and urban gardens training materials; 2) pilot data on the feasibility, acceptability, and effects of our intervention on primary outcomes and potential mediators; and 3) if results are promising, an R01 application to conduct a fully- powered cluster RCT that examines effects across a larger number of clinics in the DR.