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The Impact of a Food Assistance Program on Nutritional Status, Disease Progression, and Food Security Among People Living With HIV in Uganda

Rawat, Rahul PhD, MHS*; Faust, Elizabeth; Maluccio, John A. PhD; Kadiyala, Suneetha PhD‡,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2014 - Volume 66 - Issue 1 - p e15–e22
doi: 10.1097/QAI.0000000000000079
Implementation and Operational Research: Epidemiology and Prevention
IOR articles

Background: Although the last decade has seen increased access to antiretroviral therapy across the developing world, widespread food insecurity and undernutrition continue to compromise an effective response to the AIDS epidemic. Limited evidence exists on the potential benefit of food security and nutrition interventions to people living with HIV (PLHIV).

Methods: We capitalized on an existing intervention to PLHIV in Uganda and conducted a prospective quasi-experimental study evaluating the impact of a monthly household food basket, provided to food insecure antiretroviral therapy–naive PLHIVs for 12 months. The outcomes of interest measured at baseline and follow-up were nutritional status [body mass index; mid-upper arm circumference and hemoglobin (Hb) concentrations], disease severity (CD4 count), and 2 measures of food security: diet quality (Individual Dietary Diversity Score) and food access (Household Food Insecurity Access Scale). We used difference-in-difference propensity score matching to examine the impact of food assistance.

Results: Over 12 months, food assistance significantly increased body mass index by 0.6 kg/m2 (P < 0.01) and mid-upper arm circumference by 6.7 mm (P < 0.05). We found no impact on CD4 count, Hb concentrations, or Individual Dietary Diversity Score. Restricting the analysis to individuals with CD4 counts of greater than 350 cells per microliter, there were significant impacts on Hb concentrations (1.0 g/dL; P < 0.05). At the household level, food assistance increased the Household Food Insecurity Access Scale, by 2.1 points (P < 0.01).

Conclusions: This study demonstrates the potential for food assistance programming to be part of the standard of care for PLHIV in areas of widespread food insecurity.

*Division of Poverty, Health, and Nutrition, International Food Policy Research Institute, Washington, DC;

Department of Economics, Middlebury College, Middlebury, VT;

London School of Hygiene and Tropical Medicine, London, United Kingdom; and

§Leverhulme Centre for Integrative Research on Agriculture and Health, London, United Kingdom.

Correspondence to: Suneetha Kadiyala, PhD, 36, Gordon Square, London WC1H 0PD United Kingdom (e-mail:

Supported by Irish Aid, SIDA, the International Initiative for Impact Evaluation (3ie), Concern Worldwide, and the Regional Network on AIDS, Livelihoods, and Food Security (RENEWAL), and facilitated by the International Food Policy Research Institute (IFPRI). RENEWAL is grateful for support from Irish Aid and the Swedish International Development Cooperation Agency (SIDA).

The authors have no conflicts of interest to disclose.

The funding bodies had no role in the study design, data collection, analysis, interpretation, or article preparation.

Received November 22, 2013

Accepted November 22, 2013

© 2014 by Lippincott Williams & Wilkins