For pre-antiretroviral treatment and antiretroviral treatment patients, clinical malnutrition is a risk factor for HIV and mortality. Malnutrition can also negatively impact birth outcomes among HIV-positive women. As HIV infection progresses, challenges to maintenance of adequate nutritional status—mal-absorption of nutrients, hyper-metabolism, etc.—increase and can adversely affect adherence to and effectiveness of drug treatments.
Food by Prescription provides food and nutritional support to malnourished HIV+ individuals in the form of therapeutic and supplementary feeding at health facility levels. The project serves severely malnourished people living with HIV/AIDS, HIV+ pregnant women, HIV+ women in their first six months post-partum, their infants, and orphans and vulnerable children. To ensure the program’s success, USAID works with the Ethiopian Ministry of Health and HIV/AIDS Prevention and Control Office, as well as the Food and Nutrition Technical Assistance (FANTA) project. Food by Prescription serves as a critical component of PEPFAR, a broader effort to strengthen integration of nutrition into HIV services. In order to reduce the cost associated with importation of nutrients and food commodities, the project will also collaborate with the public and private sector to explore the possibility of local production for some of the required food commodities.
Expected Results:
Two qualitative data collection rounds were included, with the following objectives:
a) Adherence and compliance: The objective of the first was to elaborate and contextualize the findings of the quantitative impact study, by exploring ration utilization and participant perceptions of the costs and benefits of participation in the FBP program. It sought to validate the assumption that participants were receiving and consuming the rations prescribed as per the program protocol and to identify the constraining factors and solutions for improved participant adherence. This component of the study also addressed issues of service provider participation, and the barriers and constraints to delivery that may have impacted the effects of the program on individuals.
b) Default and non-response: While the first qualitative study sought to identify constraints to adherence from a group of “successful” participants, a second study was designed to investigate the experience of “unsuccessful” participants, aiming to identify possible limitations to adherence among individuals who either defaulted from the program or failed to respond to the intervention.
The objective of the second qualitative study was to understand in greater depth the range of reasons for default among FBP program participants, as well as the range of reasons for poor weight gain among other participants.
The study was designed as a quasi-experimental effectiveness evaluation, with a comparison group of clinics selected from a geographic area similar to those in which the intervention was being evaluated. Originally, the study was designed to reflect the existence of a food support program being implemented by WFP in limited urban areas for households containing individuals with HIV. As the WFP program was providing a household ration to participant households, there was a concern that the measured impact of the FBP program could be biased by the presence or absence of the WFP program.
Therefore, the study sample was stratified to include three cohorts of participants who were followed longitudinally: two groups of adult PLHIV meeting FBP enrollment criteria in ART clinics at selected health facilities, one from sites offering both the FBP program and the WFP program, and another from sites offering FBP only. Participants from these two groups were recruited for the study at the time when they enrolled in the FBP program. The third group, a comparison group, was composed of FBP-eligible adults recruited from FBP Phase II sites, i.e., where the program had not yet been rolled out but would do so during Year Two of the program.
However, after the FBP program and the impact study had commenced, the WFP program was phased out. Despite this, the three study groups were maintained, with the idea that the two treatment groups could be pooled eventually if the baseline characteristics of the two did not differ significantly.
BMI, ART status, MAM recovered and SAM recoverd
Date | User | Log | State |
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Tue, 03/11/2014 - 17:28 | engesveenk | Edited by william_nkoom. | published |
Wed, 03/27/2013 - 16:15 | bloessnerm | Edited by william_nkoom. | published |
Sun, 02/10/2013 - 17:00 | william_nkoom | Edited by william_nkoom. | draft |
Sun, 02/10/2013 - 16:59 | william_nkoom | Edited by william_nkoom. | draft |
Wed, 02/06/2013 - 01:12 | AnnaLartey | Created by AnnaLartey. | needs_review |