Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study

Tesfay, Fisaha Haile; Ziersch, Anna; Mwanri, Lillian; Javanparast, Sara

doi:10.1371/journal.pone.0231859

Cited by 7 publications

(41 citation statements)

References 47 publications

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“…A rural residence is described as a barrier to nutritional recovery. This was in concordance with other studies performed in different parts of Africa [ 17 , 21 ]. The mechanism by which rural residence leads to poor nutritional recovery in HIV patients remains unclear, but it might be because rural settings would have high levels of poverty and difficulties in accessing different health services.…”

Section: Discussionsupporting

confidence: 94%

“…This study revealed that from the total patients who were on the therapeutic feeding program, nearly two-thirds of patients were recovered from undernutrition, which is comparable with a study done in Mekelle Hospital, Ethiopia [ 16 ], but it is higher when compared with studies conducted in different parts of sub-Saharan Africa including Ethiopia [ 17 – 20 ]. Most importantly, the current findings support WHO recommendations that nutritional counseling and therapy should be implemented for undernourished HIV patients.…”

Section: Discussionsupporting

confidence: 80%

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Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study

Diress

Moges

2020

AIDS Research and Treatment

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Background. Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia. Methods. An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients’ charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery. Result. From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9–17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22–31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27–0.85), no formal education (ARR = 0.24, 95% CI: 0.13–0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08–0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17–0.59) decrease the probability of nutritional recovery. Conclusion. Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 80%

Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study

Diress

Moges

2020

AIDS Research and Treatment

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“…A key issue also identi ed as a challenge for nutrition counselling programs was a lack of focus on the context of people's lives. This study found that food insecurity and poverty were a key issue among people living with HIV enrolled in the nutritional program [38] that affected their capacity to implement some elements of the counselling. Other studies in Kenya [50], South Africa, and Ghana [51,58] have likewise demonstrated the importance of considering the individual patient's nancial and socioeconomic circumstances when providing the nutritional counselling for better effectiveness.…”

Section: Discussionmentioning

confidence: 92%

“…This study is part of a larger study that examined the determinants of nutritional outcomes and challenges of a nutritional program in the Tigray region of Ethiopia [37,38]. This paper presents ndings from a qualitative study involving individual interviews with adults living with HIV, caregivers of children living with HIV, health providers, and health managers to explore their experiences and perspectives about nutritional counselling in the nutritional program in HIV care settings.…”

Section: Methodsmentioning

confidence: 99%

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Experience of Nutritional Counselling in a Nutritional Program in HIV Care in the Tigray Region of Ethiopia Using the Socio-ecological Model

Tesfay

Ziersch

Mwanri

et al. 2020

Preprint

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Background: In many resource-poor settings, nutritional counselling is one component of nutrition support programs aiming to improve nutritional and health outcomes amongst people living with HIV. Counselling methods, contents, and recommendations that are culturally appropriate, locally tailored, and economically affordable are essential to ensure desired health and nutritional outcomes are achieved. However, there is little evidence showing the effectiveness of counselling in nutritional programs in HIV care, and the extent to which counselling policies and guidelines are translated into practice and utilised by people with HIV suffering from undernutrition. This study aimed to explore these gaps in the Tigray region of Ethiopia. Methods and participants: A qualitative study was conducted in Tigray Region Ethiopia between May and August 2016. Forty-eight individual interviews were conducted with 20 undernourished adults living with HIV and 15 caregivers of children living with HIV enrolled in a nutritional program in three hospitals, as well as 11 health providers, and 2 program managers. Data analysis was undertaken using the Framework approach and guided by the socio-ecological model. Qualitative data analysis software (QSR NVivo 11) was used to assist data analysis. The study findings are presented using the consolidated criteria for the reporting of qualitative research (COREQ). Result: The study highlighted that nutritional counselling as a key element of the nutritional program in HIV care varied in scope, content, and length. While the findings clearly demonstrated the acceptability of the nutritional counselling for participants, a range of challenges hindered the application of counselling recommendations in participants’ everyday lives. Identified challenges included the lack of comprehensiveness of the counselling in terms of providing advice about the nutritional support and dietary practice, participants’ poor understanding of multiple issues related to nutrition counselling and the nutrition program, lack of consistency in the content, duration and mode of delivery of nutritional counselling, inadequate refresher training for providers, and the absence of socioeconomic considerations in nutritional program planning and implementation. Evidence from this study suggests that counselling in nutritional programs in HIV care was not adequately structured and lacked a holistic and comprehensive approach. Conclusion: Nutritional counselling provided to people living with HIV lacks comprehensiveness, consistency, and varies in scope, content, and duration. To achieve program goal of improved nutritional status, counselling guidelines and practices should be structured in a way that takes a holistic view of patient’s life and considers cultural and socioeconomic situations. Additionally, capacity development of nutritional counsellors and health providers is highly recommended to ensure counselling provides assistance to improve the nutritional wellbeing of people living with HIV.

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Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea

Marme,

Kuzma,

Zimmerman

et al. 2024

Journal of Public Health

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Background Tuberculosis (TB) is a highly transmissible infectious disease killing millions of people yearly, particularly in low-income countries. TB is most likely to be transmitted in healthcare settings with poor infection control practices. Implementing TB infection prevention and control (TB-IPC) is pivotal to preventing TB transmission in healthcare settings. This study investigated diverse stakeholders’ perspectives relating to barriers and strategies for TB-IPC in rural hospitals in Papua New Guinea. Methods Multiple qualitative case studies were conducted with 32 key stakeholders with experience in TB services. Data collection drew on three primary sources to triangulate data: semi-structured interviews, document reviews and field notes. The data were analyzed using hybrid deductive-inductive thematic analysis. Results Our results reveal that key stakeholders perceive multiple interdependent factors that affect TB-IPC practice. The key emerging themes include strategic planning for and prioritizing TB-IPC guidelines; governance, leadership and accountability at the provincial level; community attitudes towards TB control; institutional capacity to deliver TB care, healthcare workers’ safety, and long-term partnership and integration of TB-IPC programmes into the broad IPC programme. Conclusions The evidence suggests that a multi-perspective approach is crucial for TB-IPC guidelines in healthcare institutions. Interventions focusing on addressing health systems strengthening may improve the implementation of TB-IPC guidelines.

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Contextual and individual level factors influencing nutritional program effectiveness in HIV care setting in Tigray region, northern Ethiopia: Mixed methods study

Cited by 7 publications

References 47 publications

Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study

Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study

Experience of Nutritional Counselling in a Nutritional Program in HIV Care in the Tigray Region of Ethiopia Using the Socio-ecological Model

Investigating socio-ecological factors influencing implementation of tuberculosis infection prevention and control in rural Papua New Guinea

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