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Sustained Effect of a Community-based Behavioral and Nutrition Intervention on HIV-related Outcomes among Women living with HIV in Rural India

A Quasi-experimental Trial

Nyamathi, Adeline N., PhD, ANP, FAAN1; Shin, Sanghyuk S., PhD1; Sinha, Sanjeev, MD2; Carpenter, Catherine L., PhD1; Garfin, Dana Rose, PhD1; RK, Padma, MA3; Yadav, Kartik, MSCR1; Ekstrand, Maria L., PhD4

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 04, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/QAI.0000000000002044
Original Article: PDF Only

Background: Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression.

Setting: WLH were recruited from primary-health centers in rural India.

Method: A quasi-experimental trial of a comprehensive Accredited Social Health Activist (ASHA)-supported intervention compared four distinct ASHA-based programs [1) standard education alone (SE); 2) nutrition education (+NE); 3) nutrition supplements (+NS); or 4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately post-intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time.

Findings: Among 600 WLH enrolled (n=150 per arm), mean age, CD4 count and BMI (kg/m2) were 34.31, 447.42, and 20.09, and 30.4 respectively, at baseline. At 18-month follow-up, Program 4 (+NENS) experienced greatest improvements in CD4 counts compared to Program 1 (+SE) (adjusted difference=223.81, 95% CI=170.29, 277.32). For BMI, Programs 3 (+NS; adjusted difference=2.33, 95% CI, 1.39, 3.26) and 4 (+NENS; adjusted difference=2.14, 95% CI, 1.17, 3.12) exhibited greater gains compared to Program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference=-0.18, 95% CI, -1.12, 0.76). Hemoglobin and serum albumin also improved over time; Program 4 (+NENS) exhibited the greatest gains.

Conclusions: A low-cost ASHA-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.

Trial Registration: NCT02136082

1University of California, Irvine, 826 Health Sciences Rd, Irvine, CA 92617, USA

2All India Institute of Medical Sciences, Ansari Nagar (East), AIIMS campus, New Delhi-110029, India

3Department of Medicine, All India Institute of Medical Sciences, India.

4University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA

Correspondence Should Be Addressed To: Adeline M. Nyamathi, ANP, PhD, FAAN Distinguished Professor, Founding Dean Sue & Bill Gross School of Nursing University of California, Irvine Email: +1 949 824 8932 252D Berk Hall Irvine, CA 92697

No authors have any conflicts of interests to disclose. Research was funded by National Institute of Mental Health of the National Institutes of Health under award number R01MH098729 to Dr. Adeline M. Nyamathi.

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