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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


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


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


          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.


          Among 600 WLH enrolled ( n=150 per arm), mean age, CD4 count and BMI (kg/m 2) 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.


          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:

          ClinicalTrials.gov: [Related object:]NCT02136082

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          Author and article information

          J Acquir Immune Defic Syndr
          J. Acquir. Immune Defic. Syndr.
          Journal of acquired immune deficiency syndromes (1999)
          9 April 2019
          01 August 2019
          01 August 2020
          : 81
          : 4
          : 429-438
          University of California, Irvine, 826 Health Sciences Rd, Irvine, CA 92617, USA
          University of California, Irvine, 826 Health Sciences Rd, Irvine, CA 92617, USA
          All India Institute of Medical Sciences, Ansari Nagar (East), AIIMS campus, New Delhi-110029, India
          University of California, Los Angeles, 900 Veteran Ave, Los Angeles, CA 90095, USA
          University of California, Irvine, 826 Health Sciences Rd, Irvine, CA 92617, USA
          Department of Medicine, All India Institute of Medical Sciences, India.
          University of California, Irvine, 826 Health Sciences Rd, Irvine, CA 92617, USA
          University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143, USA
          Author notes

          Author contributions

          AN conceived the idea for the study, and ME and SS added critical details to the design. All three developed the metrics, secured funding, oversaw all aspects of the study procedures and data interpretation. AN took the lead on the introduction, methods, and discussion of this manuscript. CC developed the nutrition intervention and contributed to the final review of the manuscript. ME contributed to the final editing and review of the manuscript. DRG conducted the data analysis and literature review and contributed to the introduction, methods, results and discussion sections. RK Padma was actively involved in data collection in India and reviewed the final manuscript. KY led study conduct, data collection, and data management and contributed to the methods and measures. SShin contributed to the data analysis and the final editing of the manuscript. SSinha oversaw study procedures and protocol adherence in India and contributed to the final editing and review of the manuscript. Authors have no financial disclosures.

          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, anyamath@ 123456uci.edu , +1 949 824 8932, 252D Berk Hall, Irvine, CA 92697
          PMC6594881 PMC6594881 6594881 nihpa1523970


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