Tailored nutrition and food security interventions in comprehensive HIV care

描述（由申请人提供）：尽管最近在艾滋病毒护理方面取得了巨大进展，但发展中国家与艾滋病毒/艾滋病有关的发病率和死亡率仍然高得令人无法接受。一个主要的促成因素是，在发展中国家，8亿多人长期营养不良，饥饿和艾滋病毒的流行重叠。随着艾滋病毒感染的进展，它会导致分解代谢状态，而热量摄入不足和感染易感性增加会加剧这种状态，导致营养不良恶化。粮食不安全涉及粮食和保健之间的竞争性选择，有可能损害对艾滋病毒治疗的坚持。世界卫生组织、联合国艾滋病毒/艾滋病联合规划署和世界银行最近都强调，营养干预措施应与抗逆转录病毒治疗方案系统地联系起来。尽管如此，缺乏关于如何在艾滋病毒护理方面有效实施营养方案的数据;缺乏关于粮食援助是否为艾滋病毒感染者或其家庭成员带来临床或营养益处的数据。我们的研究小组由艾滋病毒护理领域的专家组成，并与营养，经济发展和粮食安全以及国际艾滋病毒政策方面的专家合作，在资源贫乏的环境中进行方案研究。该小组在实现以下四个具体目标方面处于独特的地位：1）为海地农村地区艾滋病毒感染者及其家庭制定一个有针对性的食品篮，并辅之以教育干预; 2）在海地农村地区建立一个由500个家庭组成的队列，每个家庭至少有一名成员感染艾滋病毒，并对他们进行为期36个月的跟踪，收集人口统计数据，艾滋病毒疾病进展、生活质量、营养状况、粮食安全和家庭经济指标; 3）确定与艾滋病毒治疗方案挂钩的12个月定制食品篮对感染艾滋病毒的海地农村人及其家庭的临床、营养和经济结果的影响，并与未接受此类干预措施的类似受影响家庭进行比较;（4）评估干预的成本和成本效益。我们假设，与没有接受这种干预的艾滋病毒感染者及其家庭相比，定制的食物篮子：i）与艾滋病毒感染者的临床结果和生活质量有关; ii）与艾滋病毒感染者及其家庭成员的营养结果改善有关; iii）与更好的家庭粮食安全和经济福利相关，以及iv）按国际标准衡量具有成本效益。通过实现这四个具体目标，这项重新提交的新研究者R 01研究将提供急需的证据，以优化艾滋病毒项目和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，以确保所有人的健康，生产力，独立性和福祉通过最佳康复。 公共卫生相关性：通过确定为艾滋病毒感染者及其家庭量身定制的食物篮子的临床，营养和生活质量益处，这项前瞻性随机分组队列研究将为改善全球卫生紧迫性的两个问题的管理提供关键证据：营养不足和艾滋病毒感染。此外，通过确定干预措施的成本和成本效益，这项研究将为医生、患者和决策者提供重要数据，为发展中国家的艾滋病毒和营养方案规划和政策提供信息。

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.