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

描述（由申请人提供）：拉丁美洲和加勒比地区（LAC）是世界上受艾滋病毒/艾滋病影响第二大的地区。虽然获得艾滋病毒抗逆转录病毒治疗的机会大幅增加，提高了人们对拉丁美洲和加勒比可能很快实现普遍获得治疗的期望，但患者、提供者和艾滋病毒治疗倡导者往往认为营养不良和粮食不安全是获得和坚持抗逆转录病毒治疗的主要障碍。抗逆转录病毒疗法需要定期就医，这涉及运输费用和工作时间损失，从而减少了家庭可用于购买粮食的资金。开始治疗但不能遵循食物和营养建议的人可能会增加药物副作用，造成明显的不适，甚至抑制进食，这可能导致治疗中断或停止。依从性差反过来又导致治疗失败以及耐药性的发展和传播。营养不良也会影响药物代谢的功效。因此，促进粮食安全和有效的营养支持对于确保最佳的抗逆转录病毒疗法的吸收、坚持和结果至关重要。这项研究是由兰德公司、联合国世界粮食计划署（WFP）在拉丁美洲的项目工作人员和洪都拉斯的社区合作伙伴共同提出的。该项目将分两个阶段进行。第一阶段采用定性的、形成性的研究方法，以（1）了解当地食物和常规饮食的可获得性和成本，（2）评估艾滋病毒感染者的粮食安全水平，包括家庭内的粮食分配模式，并评估受艾滋病毒影响的个人的营养状况，（3）审查粮食安全和营养在获得艾滋病毒治疗方面发挥的作用，使用和坚持。第二阶段将通过在洪都拉斯的4个艾滋病毒诊所进行的随机对照试验（两个诊所被随机分配到干预组，两个诊所被随机分配到对照组），开发和试点测试多成分营养干预。所有地点的患者都将接受营养咨询，遵循世界卫生组织目前提出的作为艾滋病毒感染者护理标准的指导方针。此外，干预点的服务对象将得到多成分营养干预，其中包括粮食援助和旨在满足受艾滋病毒影响个人具体需要的多种微量营养素组合。作为首批系统地研究粮食安全、营养状况和多成分营养干预对资源有限环境中艾滋病毒感染者的艾滋病毒治疗保留、利用和坚持的作用的研究之一，拟议的研究具有巨大的潜力为更大规模的营养干预措施评估提供信息，更普遍地说，在拉丁美洲和其他发展中国家为艾滋病毒感染者提供食品援助计划。这项为期三年的研究的目的是制定、实施和试点测试一种文化上适当的、多成分的食物和营养干预措施，以提高洪都拉斯艾滋病毒感染者和粮食不安全者的治疗依从性，洪都拉斯是艾滋病毒流行率最高的拉丁美洲国家之一。

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.