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

近年来，在拉丁美洲和拉丁美洲，艾滋病毒抗逆转录病毒疗法(ART)的可及性显著增加。 加勒比(LAC)，特别是多米尼加共和国(DR)；然而，粮食不安全和贫穷 营养已经成为艾滋病病毒携带者(PLHIV)使用和坚持抗逆转录病毒治疗的障碍， 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PLHIV报告为中度或 严重的粮食不安全。大多数方案旨在解决低资源地区艾滋病毒感染者中的粮食不安全问题 环境涉及提供食物补充，取得了积极的结果；然而，这种努力通常是 这是不可持续的。此外，大多数干预措施主要集中在体重不足而超重的艾滋病毒感染者身上。 肥胖也是一个日益令人担忧的问题。可持续的方法，增加获得粮食的机会，还 需要促进艾滋病毒感染者之间的均衡营养。城市园艺与同行营养同在 咨询是一种潜在的解决方案。这项为期三年的研究的目的是制定、实施和 评估适合文化的多组件的可行性、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治疗 DR中对PLHIV的依从性和病毒学抑制具体目的是：(1)使用形成性研究 关于饮食模式和当地可获得的食物，以及我们对营养咨询的初步研究 和城市园艺，制定一项多成分营养干预措施，以解决 PLHIV，将适合文化的、同行主导的营养教育与可持续的城市花园相结合 (2)评价城市园林绿化的可行性、可接受性和初步效果 同伴营养咨询改善我们的主要结果(HIV护理保留、ART依从性和 病毒抑制)短期(6个月)和长期(12个月)；以及(3)探索初步 对潜在介体的干预效果(粮食安全、营养状况、内化的艾滋病毒污名和社会 支持)，这些都是次要结果。这项拟议的研究涉及来自 兰德，加州大学旧金山分校(UCSF)和圣多明各自治大学和 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)的方案工作人员， 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基础上 在拉丁美洲和加勒比其他地方工作，并在兰德、粮食计划署和DR AS的当地合作伙伴之间建立了关系 首批通过同伴营养咨询开发可持续食品生产方法的研究之一 PLHIV，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；以及3)如果结果是有希望的，R01申请进行全面的- 支持的集群RCT检查了DR中更多诊所的影响。

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.