Adherence to ready-to-use food and acceptability of outpatient nutritional therapy in HIV-infected undernourished Senegalese adolescents: research-based recommendations for routine care

Abstract

Background Ready-to-use food (RUF) is increasingly used for nutritional therapy in HIV-infected individuals. However, practical guidance advising nutrition care to HIV-infected adolescents is lacking, so that little is known about the acceptability of such therapy in this vulnerable population. This study assesses the overall acceptability and perception of a RUF-based therapy and risk factors associated with sub-optimal RUF intake in HIV-infected undernourished adolescents in Senegal. Methods Participants 5 to 18 years of age with acute malnutrition were enrolled in 12 HIV clinics in Senegal. Participants were provided with imported RUF, according to WHO prescription weight- and age-bands (2009), until recovery or for a maximum of 9–12 months. Malnutrition and recovery were defined according to WHO growth standards. Adherence was assessed fortnightly by self-reported RUF intake over the period. Sub-optimal RUF intake was defined as when consumption of the RUF provision was < 50%. RUF therapy acceptability and perceptions were assessed using a structured questionnaire at week 2 and focus group discussions (FGDs) at the end of the study. Factors associated with sub-optimal RUF intake at week 2 were identified using a stepwise logistic regression model. Results We enrolled 173 participants, with a median age of 12.5 years (Interquartile range: 9.5–14.9), of whom 61% recovered from malnutrition within the study period. Median follow-up duration was 66 days (21–224). RUF consumption was stable, varying between 64 and 57% of the RUF provided, throughout the follow-up. At week 2, sub-optimal RUF intake was observed in 31% of participants. Dislike of the taste of RUF (aOR = 5.0, 95% CI: 2.0–12.3), HIV non-disclosure (5.1, 1.9–13.9) and food insecurity (2.8, 1.1–7.2) were the major risk factors associated with sub-optimal RUF intake at week 2. FGDs showed that the need to hide from others to avoid sharing and undesirable effects were other constraints on RUF feeding. Conclusions This study revealed several factors reducing the acceptability and adherence to RUF therapy based on WHO guidelines in HIV-infected adolescents. Tailoring prescription guidance and empowering young patients in their care are crucial levers for improving the acceptability of RUF-based therapy in routine care. Trial registration ClinicalTrials.gov identifier: NCT03101852, 04/04/2017.

Assessment of dietary diversity and nutritional support for children living with HIV in the IeDEA pediatric West African cohort: a non-comparative, feasibility study

“…Adherence to nutritional products was not optimal in our study. These results were also documented for the use of RUTF in acutely malnourished children and adolescents living with HIV in Senegal [ 34 , 35 ], with for example reports of disgust feelings, self-stigma and practices of sharing with the households. In Mali, the RUTF consumption was also reported as incomplete for one third of the study population [ 29 ].…”

Nutritional status and its determinants among adolescents with HIV on anti-retroviral treatment in low- and middle-income countries: a systematic review and meta-analysis

“…These 17 primary articles recruited a total of 2873 study participants in LMICs. The majority of articles ( n = 11, 64.7%) were cross-sectional studies [ 19 – 27 ], whilst the remainder ( n = 6, 35.3%) comprised: observational studies ( n = 3) [ 28 – 30 ]; case–control study ( n = 1) [ 31 ]); mixed-method study ( n = 1) [ 32 ], and one clinical trial [ 33 ] (Table 1 ).…”

“…Studies were conducted in seven LMIC countries in South American, Asian and African continents. The majority ( n = 7, 41.2%) took place in upper-middle income countries [ 19 , 21 , 22 , 27 , 28 , 30 , 34 ], followed by low-middle income countries ( n = 5, 29.4%) [ 26 , 29 , 32 , 33 ] and low- income countries (29.4%) [ 20 , 23 – 25 , 35 ] (Table 1 ).…”

“…It may indicate that implementation is not progressing as expected. However, there is evidence that nutrition interventions result in beneficial effects [ 29 , 33 ]. Effective interventions and strategies therefore need to be better implemented to address multiple challenges in communities and sectors.…”

Feasibility trial for the management of severe acute malnutrition in older children with sickle cell anemia in Nigeria

“… 46 , 47 In children with HIV aged from 5 to 18 years, 38% of caregivers and participants reported sharing ready-to-use food (RUF), with caregivers reporting that they felt other adults or children needed the RUF. 48 In a study for outpatient treatment of severe and moderate malnutrition in children with HIV, 32% of caregivers admitted to consuming the RUF themselves. 49 Strategies to reduce sharing, such as the rationalization of RUF prescription, the enrollment of other undernourished family members in RUF therapy, and food complements for the household, have not been systematically evaluated.…”