Retention and Treatment Outcomes of an Undernutrition Program for HIV patients involving Ready-to-Use Therapeutic Food at Gondar University Hospital, Ethiopia: A Cross-Sectional Study

Time to Nutritional Recovery and Its Predictors Among Undernourished Adult Patients Living with Human Immune Deficiency Virus Attending Anti-Retroviral Therapy at Public Health Facilities in Southwest Ethiopia. A Multicenter Study

Background

Infection with the human immunodeficiency virus is one of the factors that contribute to malnutrition. Several initiatives have been launched in Ethiopia to improve HIV patients’ nutritional status and achieve early recovery when malnourished patients are found. Despite these efforts, adult HIV patients’ malnutrition recovery remains poor.

Objective

The objective of this study was to assess the time to recovery from undernutrition and associated factors among adult HIV patients on ART at public health facilities in Ilu Aba Bor zone, Southwest Ethiopia, 2021.

Methods

An institution-based retrospective cohort study of 374 adult HIV patients with undernutrition receiving ART at public health institutions in Southwest Ethiopia was conducted. Data were extracted from the patient’s record and entered into Epi-Data version 3.1 before being exported to STATA version 14. The Kaplan–Meier method was used to estimate the time to recovery, and the difference in survival time between predictor variables was tested using the Log rank test. Weibull regression models, both bivariable and multivariable, were fitted. A p-value of 0.05 was declared statistically significant.

Results

The recovery rate was 67.7% and the median recovery time was 65 days (95% CI = 61.6–68.4) and 145 days (95% CI = 130.7–159) for MAM and SAM, respectively. Marital status (Married) (AHR = 0.61; CI = (0.43,0.86)), ART status (pre ART) AHR = 0.492; CI = (0.305,0.793), CD4 (200-350c/m3, AHR = 2.116;CI = (1.447,3.21), type of malnutrition (AHR = 0.22; CI= (0.156,0.307)), ART adherence level (AHR = 3.33, CI = (1.997,5.56)) WHO clinical staging (AHR = 0.685, CI = (0.485,0.948)), sex (male), (AHR = 0.678; CI = (0.509,0.901)) and age (35–54), (AHR = 1.86; CI = (1.408,2.47)) were predictors of recovery time.

Conclusion

Compared to previous studies, the recovery rate was high. SAM, advanced clinical stage, sex, and marital status were all negatively associated with nutritional recovery time, whereas ART adherence, CD4 count, and age were predictors. As a result, a therapeutic feeding program should focus on factors that slow recovery time.

Effects of nutritional supplementation on glucose metabolism and insulin function among people with HIV initiating ART

Background

Without high-quality nutritional support, there is a risk that people infected with human immunodeficiency virus (HIV) will replace lost muscle mass with fat mass when initiating antiretroviral therapy (ART). We have shown that lipid-based nutrient supplements (LNS) with whey or soy considerably increases lean mass among Ethiopian people with HIV starting ART. Here, we aim to assess the effects of LNS on insulin function and glucose metabolism.

Methods

This is a secondary analysis of a randomized trial testing the effect of three-month supplementation with LNS containing whey (LNS/whey) or soy (LNS/soy) among people with HIV. LNS/whey and LNS/soy groups were combined and then were compared against the non-supplemented group. The outcomes were change in fasting plasma-glucose (FPG), and 30-min glucose and 120-min glucose after oral glucose tolerance test. We further assessed effect on glycated hemoglobin (HbA1c), fasting insulin, homeostatic model assessment index for beta-cell function (HOMA-B) and insulin resistance (HOMA-IR).

Results

Of the 318 patients enrolled, 268 (84.3%) had available FPG and HbA1c and included. After 3 months of ART, HbA1c tended to be 2 mmol/mol higher in the LNS supplemented group, most pronounced among those receiving whey as the protein source. LNS led to higher 30-min glucose (0.5 mmol/L, 95% CI 0.2, 0.8) and 120-min glucose (0.4 mmol/L, 95% CI 0.03, 0.8) and a > 50% increase in fasting insulin, HOMA-B and HOMA-IR compared to the non-supplemented.

Conclusion

Among Ethiopian people with HIV initiating ART, short-term LNS intake increased glucose and insulin levels, and tended to increase HbA1c, potentially leading to more insulin resistance. Higher intake of carbohydrates with LNS could influence glycemic status. Whether these metabolic changes in early HIV treatment are beneficial or increase long-term risk of metabolic disorders needs to be explored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-021-00462-y.

Predictors of recovery rate among undernourished HIV-positive adults treated with ready-to-use therapeutic food at Debre Markos Comprehensive Specialized Hospital: A retrospective cohort study

BACKGROUND

Nutritional support is becoming more widely acknowledged as a crucial component of the key package of care for HIV/AIDS patients. This nutritional support is exceptionally important for patients in sub-Saharan Africa, including Ethiopia, where HIV/AIDS is very prevalent. However, there is a lack of evidence on the recovery rate and predictors at the study site and at large in Ethiopia. Therefore, this study will give some insight into the recovery rate and its predictors among under-nourished HIV-positive adults treated with Ready to Use Therapeutic Food (RUTF) attending at Debre Markos referral hospital. Moreover, the findings of this study will be used by both governmental and non-governmental organizations to allocate more resources to mitigate the nutritional problems for people living with HIV.

METHODS

An institution-based retrospective cohort study was conducted among 453 under-nourished HIV positive adults treated with RUTF at Debre Markos referral Hospital from the 1st of July, 2015 to the 31st of December, 2017. The study participants were selected using a simple random sampling technique. Data were extracted from patient charts using a standardized data extraction checklist. Data were entered into Epi-Data Version 4.2 and analyzed using Stata Version 14. The Kaplan-Meier survival curve was used to estimate the time to recovery. Log-rank test was used to compare the recovery time between different baseline categorical variables. The bivariable and multivariable Cox-proportional hazard regression models were fitted for potential predictors of recovery time. Adjusted hazard Ratios (AHRs) with 95% CIs were used to measure the strength of association and test statistical significance.

RESULTS

A total of 453 undernourished HIV-positive adults were included in the final analysis. About 201, 44.4% (95%CI: 38.9, 49.0%) patients participating in the RUTF program were recovered based on predetermined exit criteria with incidence of 10.65 (95% CI: 9.28, 12.23) per 100 person-month observations. Being moderately undernourished (AHR: 11.0, 95% CI: 5.3, 23.1), WHO clinical stage (I or II) (AHR:1.8, 95% CI: 1.2, 2.6), and working functional status at baseline (AHR = 2.34, 95%CI: 1.01,5.45) were predictors of recovery time.

CONCLUSION

This study concluded that the overall nutritional recovery rate was below the acceptable minimum requirement which at least 75% of patients should recovered. Mild to moderate undernutrition at baseline, WHO clinical stage I or II at enrolment, and working functional status were found to be predictors of recovery time in HIV/AIDS patients treated with the RUTF. As a result, special attention should be paid to severely malnourished patients, WHO clinical stages III or higher, and patients who are bedridden or ambulatory during treatment.

Nutritional Recovery and Its Predictors among Adult HIV Patients on Therapeutic Feeding Program at Finote-Selam General Hospital, Northwest Ethiopia: A Retrospective Cohort Study

Background

Undernutrition is a major public health problem in HIV patients in sub-Saharan Africa. To address the problem of malnutrition, the Ethiopian Ministry of Health implemented a therapeutic feeding program, which is the provision of nutritional treatment, care, and support for undernourished individuals. However, little is known about the outcome of a therapeutic feeding program. Therefore, this study aimed to assess nutritional recovery and its predictors among undernourished HIV patients enrolled in a therapeutic feeding program in Northwest Ethiopia.

Methods

An institutional-based retrospective cohort study was conducted among 376 randomly selected adult undernourished HIV patients enrolled in the therapeutic feeding program from July 2010 to January 2017 at Finote-Selam General Hospital. Data were collected by reviewing patients' charts, follow-up cards, and undernutrition treatment registration books using a pretested structured checklist. The main outcome variable was nutritional recovery, defined based on body mass index. Bivariable and multivariable log-binomial regression models were used to identify the predictors of nutritional recovery.

Result

From total undernourished HIV patients enrolled in the therapeutic feeding program, 61.2% were recovered with a median recovery time of 12 weeks (IQR 9–17 weeks) for moderate acute malnutrition and 25 weeks (IQR 22–31 weeks) for severe acute malnutrition. Rural residence (adjusted risk ratio (ARR) = 0.53, 95% CI: 0.27–0.85), no formal education (ARR = 0.24, 95% CI: 0.13–0.54), poor ART adherence level (ARR = 0.14, 95% CI; 0.08–0.32), and WHO clinical stage III or IV (ARR = 0.38, 95% CI; 0.17–0.59) decrease the probability of nutritional recovery.

Conclusion

Nutritional supplementation plays a critical role in the nutritional care and treatment of malnourished patients. Healthcare providers should give more attention to persons with poor adherence levels, advanced WHO clinical stage, rural residence, and low educational status. Future prospective follow-up studies should be performed to assess important variables such as family income, food sharing at the household level, and distance to health institutions.

Identifying and Reengaging Patients Lost to Follow-Up in Rural Africa: The "Horizontal" Hospital-Based Approach in Uganda

Between 30% and 60% of hospital outpatient clinic patients were lost to follow-up. A defaulter-tracking service using performance-based remuneration for outreach workers, cutting across different clinical services, improved patient retention overall but varied by disease, with the poorest outcomes among patients with HIV.

Among the many challenges facing health systems grappling with the explosive growth of chronic disease in Africa are continuity of care, particularly in poor, rural areas. We report the strategy, field experience, and results of an ongoing 6-year follow-up program operating in a rural district hospital in Kisoro, Uganda, that attempts to locate and reengage patients lost to follow-up (LTFU) from communities that are largely without phones, addresses, or paved roads. The program works with diverse hospital clinics, including chronic diseases, HIV, tuberculosis (TB), nutrition, and women's health, to identify patients who have not returned to care, employing a modest staff who spend about 20 days monthly making outreach visits by motorcycle in search of approximately 130 patients. We describe the organization of this unique “horizontal” program and report on follow-up outcomes between November 2015 to October 2016. Between 30% and 60% of patients were found to have lapses in care. The follow-up program was able to locate 64% of patients, with a reengagement rate of 54% to 92% (average, 69%) depending on the clinic. The program costs approximately US$5 per patient LTFU but about US$40 per patient maintained in care. The hospital-based follow-up program that cuts across diverse clinics and wards was novel and feasible in this rural sub-Saharan African setting.