Descriptive Characteristics and Health Outcomes of the Food by Prescription Nutrition Supplementation Program for Adults Living with HIV in Nyanza Province, Kenya

Abstract

BackgroundThe clinical effects and potential benefits of nutrition supplementation interventions for persons living with HIV remain largely unreported, despite awareness of the multifaceted relationship between HIV infection and nutrition. We therefore examined descriptive characteristics and nutritional outcomes of the Food by Prescription (FBP) nutrition supplementation program in Nyanza Province, Kenya.MethodsDemographic, health, and anthropometric data were gathered from a retrospective cohort of 1,017 non-pregnant adult patients who enrolled into the FBP program at a Family AIDS Care and Education Services (FACES) site in Nyanza Province between July 2009 and July 2011. Our primary outcome was FBP treatment success defined as attainment of BMI>20, and we used Cox proportional hazards to assess socio-demographic and clinical correlates of FBP treatment success.ResultsMean body mass index was 16.4 upon enrollment into the FBP program. On average, FBP clients gained 2.01 kg in weight and 0.73 kg/m2 in BMI over follow-up (mean 100 days), with the greatest gains among the most severely undernourished (BMI <16) clients (p<0.001). Only 13.1% of clients attained a BMI>20, though 44.5% achieved a BMI increase ≥0.5. Greater BMI at baseline, younger age, male gender, and not requiring highly active antiretroviral therapy (HAART) were associated with a higher rate of attainment of BMI>20.ConclusionThis study reports significant gains in weight and BMI among patients enrolled in the FBP program, though only a minority of patients achieved stated programmatic goals of BMI>20. Future research should include well-designed prospective studies that examine retention, exit reasons, mortality outcomes, and long-term sustainability of nutrition supplementation programs for persons living with HIV.

Shamba Maisha

“…At least 70% of HIV-infected individuals in East Africa are food insecure [32, 33] suggesting relevance of such interventions for a large segment of the population. Food insecurity in the region stems from combined effects of extreme poverty, environmental change, insufficient agricultural output, and rising food prices [34, 35], all factors that may be improved by this intervention.…”

“I Have Remained Strong Because of That Food”: Acceptability and Use of Lipid-Based Nutrient Supplements Among Pregnant HIV-Infected Ugandan Women Receiving Combination Antiretroviral Therapy

“…Such information is important because although LNS and other supplements are currently provided to pregnant women as part of a number of programs, including Food by Prescription [22,47], their actual use and impact are almost entirely unknown. Our findings here suggest that the plausibility of positive health impacts of supplementation during pregnancy is high and negative psychosocial or physical health consequences seems low, but that further larger studies are needed to determine the health and behavioral impacts, cost-effectiveness, scalability, and sustainability of various supplementation regimens.…”

“…Second, the number of supplementation studies conducted among HIV-infected pregnant women is limited, and all have focused on micronutrients [15]. Indeed, the clinical effects and other benefits of macronutrient supplementation for the general population of people living with HIV (PLHIV) remain largely unknown [22–24]. There are even fewer data about the effects of macronutrient supplementation on pregnant and lactating women, with a notable exception of the BAN study, which provides important insights into macronutrient supplementation during lactation [25,26].…”

Around the Table: Food Insecurity, Socioeconomic Status, and Instrumental Social Support among Women Living in a Rural Kenyan Island Community

“…Food insecurity may be greater during the lean season if household agricultural production declines and families must begin to purchase foods in the market, particularly when prices rise during the off season (Becquey et al 2012). Although free macronutrient supplementation rations are available for the most undernourished individuals (Nagata et al 2014), these are also subject to availability and experience shortages.…”

“…Mfangano is situated in Homa Bay County where 27.1% of adult residents are living with HIV (Ministry of Health, Republic of Kenya, 2013), most residents practice subsistence farming and fishing (Nagata et al 2011; Fiorella et al 2014), and food insecurity is common (Nagata et al 2013; Nagata et al 2011; Nagata et al 2014). …”