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

Abstract

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/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.

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:

ClinicalTrials.gov: [Related object:]NCT02136082

Contributors

Adeline N. Nyamathi

Sanghyuk S. Shin

Sanjeev Sinha

Catherine L. Carpenter

Dana Rose Garfin

Padma RK

Kartik Yadav

Maria L. Ekstrand

Journal

Journal ID (nlm-journal-id): 100892005

Journal ID (pubmed-jr-id): 21821

Journal ID (nlm-ta): J Acquir Immune Defic Syndr

Journal ID (iso-abbrev): J. Acquir. Immune Defic. Syndr.

Title: Journal of acquired immune deficiency syndromes (1999)

ISSN (Print): 1525-4135

ISSN (Electronic): 1944-7884

Publication date Nihms-submitted: 9 April 2019

Publication date (Print): 01 August 2019

Publication date PMC-release: 01 August 2020

Volume: 81

Issue: 4

Pages: 429-438

Affiliations

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 , [phone], 252D Berk Hall, Irvine, CA 92697

Article

Accession ID: PMC6594881 Pmcid ID: PMC6594881 Pmc-uid ID: 6594881 Manuscript ID: nihpa1523970

DOI: 10.1097/QAI.0000000000002044

PMC ID: 6594881

PubMed ID: 30973547

SO-VID: 40fac9ba-13b4-4310-8173-4ae518bd14f9

Categories

Subject: Article