Tailored nutrition and food security interventions in comprehensive HIV care

艾滋病毒综合护理中的定制营养和粮食安全干预措施

• 批准号: 7842591
• 负责人: Louise C. Ivers
• 金额: $ 30.15万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2013-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7842591
• 关键词: AIDS/HIV problem; Adherence; Affect; Caring; Clinical; Cohort Studies; Coupled; Data; Developing Countries; Dietary Intervention; Disease Progression; Economic Development; Economics; Educational Intervention; Effectiveness of Interventions; Energy Intake; Ensure; Epidemic; Food; HIV; HIV Infections; Haiti; Health; Healthcare; Household; Hunger; Individual; Infection; International; Intervention; Intervention Studies; Joints; Link; Malnutrition; Mission; Morbidity - disease rate; National Institute of Child Health and Human Development; Nutritional; Nutritional status; Outcome; Patients; Personal Satisfaction; Physicians; Policies; Positioning Attribute; Predisposition; Productivity; Quality of life; Randomized; Rehabilitation therapy; Research; Research Personnel; Resources; Risk; Rural; Social Welfare; United Nations; World Bank; World Health Organization; antiretroviral therapy; cohort; cost; cost effective; cost effectiveness; demographics; economic outcome; food security; global health; improved; member; mortality; nutrition; programs; prospective; public health relevance; treatment program

DESCRIPTION (provided by applicant): Despite tremendous recent advances in HIV care, morbidity and mortality related to HIV/AIDS in the developing world remain unacceptably high. A major contributing factor is that in developing countries over 800 million people are chronically undernourished and the epidemics of hunger and HIV overlap. As HIV infection progresses, it causes a catabolic state which is compounded by lack of caloric intake and increased susceptibility to infection, leading to worsening malnutrition. Food insecurity involves competing choices between food and healthcare that risks compromising adherence to HIV treatment. The World Health Organization, the Joint United Nations Program on HIV/AIDS and the World Bank have all recently emphasized that nutrition interventions should be systematically linked to antiretroviral therapy programs. Despite this, data are lacking on how to effectively implement nutrition programs in the context of HIV care; on whether food assistance results in clinical or nutritional benefits for those with HIV infection or their household members. Our research group comprises experts in the fields of HIV care and programmatic research in resource-poor settings partnered with experts in nutrition, economic development and food security as well as international HIV policy. This group is in a unique position to fulfill the following four specific aims: 1) To develop a tailored food basket coupled with an educational intervention for individuals with HIV infection and their households in rural Haiti; 2) To develop a cohort of 500 households in rural Haiti, each with at least one member with HIV infection, and follow them for 36 months, collecting data on demographics, HIV disease progression, quality of life, nutritional status, food security, and household economic indicators; 3) To determine the impact of 12 months of the tailored food basket linked to an HIV treatment program on the clinical, nutritional and economic outcomes of rural Haitians with HIV infection and their households, compared to similarly-affected households that do not receive such an intervention; 4) To evaluate the cost and cost-effectiveness of this intervention. We hypothesize that, compared to individuals with HIV and their households that do not receive such an intervention, a tailored food basket is: i) associated with better clinical outcomes and quality of life in individuals with HIV infection; ii) associated with improved nutritional outcomes in those with HIV infection and their household members; iii) associated with better household food security and economic welfare, and iv) is cost- effective by international standards. By fulfilling the four specific aims, this resubmitted, new investigator R01 study will provide critically needed evidence to optimize the link between HIV programs and nutrition interventions, and fulfills the National Institute of Child Health and Human Development's mission to ensure the health, productivity, independence, and well-being of all people through optimal rehabilitation. PUBLIC HEALTH RELEVANCE: By determining the clinical, nutritional and quality of life benefits of a tailored food basket to those with HIV infection and their households, this prospective cohort study with group randomization will contribute critical evidence towards improving the management of two issues of global health urgency: under nutrition and HIV infection. In addition, by determining the cost and cost-effectiveness of the intervention, the study will provide physicians, patients and policymakers with critical data to inform HIV and nutrition programming and policy in developing country settings.

描述（由申请人提供）：尽管艾滋病毒护理最近取得了巨大进展，与发展中国家的艾滋病毒/艾滋病有关的发病率和死亡率仍然令人难以接受。一个主要的因素是，在发展中国家，超过8亿人的营养不足，饥饿和艾滋病毒的流行病重叠。随着艾滋病毒感染的发展，它会导致分解代谢状态，由于缺乏热量摄入和增加感染的易感性而使营养不良恶化。粮食不安全涉及粮食和医疗保健之间的竞争选择，这些选择有可能损害对艾滋病毒治疗的依从性。世界卫生组织，联合联合国艾滋病毒/艾滋病联合计划和世界银行最近都强调，营养干预措施应系统地与抗逆转录病毒疗法计划联系起来。尽管如此，在艾滋病毒护理的背景下如何有效地实施营养计划的数据仍缺乏数据；关于粮食援助是为艾滋病毒感染者还是家庭成员带来临床或营养益处。我们的研究小组包括与营养，经济发展和粮食安全专家以及国际艾滋病毒政策的艾滋病毒护理和程序研究领域的专家。该群体处于实现以下四个特定目标的独特位置：1）开发一个量身定制的食物篮，并为艾滋病毒感染的人及其在海地农村地区的家庭进行教育干预； 2）在海地农村建立500个家庭，每个家庭至少有一个患有艾滋病毒感染的成员，并关注他们36个月，收集有关人口统计数据，艾滋病毒疾病进展，生活质量，生活质量，营养状况，粮食安全和家庭经济指标的数据； 3）确定与艾滋病毒感染及其家庭的临床，营养和经济成果有关的12个月量身定制的食物篮子对艾滋病毒感染及其家庭的临床，营养和经济成果的影响，与未接受这种干预的类似家庭相比； 4）评估此干预措施的成本和成本效益。我们假设，与艾滋病毒及其家庭没有这样干预的人相比，量身定制的食物篮子是：i）与艾滋病毒感染患者更好的临床结果和生活质量相关； ii）与艾滋病毒感染及其家庭成员的营养成果改善相关； iii）与更好的家庭粮食安全和经济福利相关，并且iv）符合国际标准的成本效益。通过实现这四个特定目标，这项重新提交的新研究者R01研究将提供迫切需要的证据，以优化艾滋病毒计划与营养干预措施之间的联系，并履行国家儿童健康和人类发展研究所的使命，以确保通过最佳居住居民来确保所有人的健康，生产力，独立性以及对所有人的福祉。 公共卫生相关性：通过确定量身定制的食物篮对艾滋病毒感染及其家庭的临床，营养和生活质量益处，这项具有小组随机分组的前瞻性队列研究将为改善全球健康紧迫性的管理：在营养和艾滋病毒感染下的两个问题。此外，通过确定干预措施的成本和成本效益，该研究将为医生，患者和决策者提供关键数据，以告知发展中国家环境中的艾滋病毒和营养计划和政策。