Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study.
BACKGROUND
Few data are available to guide programmatic solutions to the overlapping problems of undernutrition and HIV infection. We evaluated the impact of food assistance on patient outcomes in a comprehensive HIV program in central Haiti in a prospective observational cohort study.


METHODS
Adults with HIV infection were eligible for monthly food rations if they had any one of: tuberculosis, body mass index (BMI) <18.5kg/m2, CD4 cell count <350/mm3 (in the prior 3 months) or severe socio-economic conditions. A total of 600 individuals (300 eligible and 300 ineligible for food assistance) were interviewed before rations were distributed, at 6 months and at 12 months. Data collected included demographics, BMI and food insecurity score (range 0 - 20).


RESULTS
At 6- and 12-month time-points, 488 and 340 subjects were eligible for analysis. Multivariable analysis demonstrated that at 6 months, food security significantly improved in those who received food assistance versus who did not (-3.55 vs -0.16; P < 0.0001); BMI decreased significantly less in the food assistance group than in the non-food group (-0.20 vs -0.66; P = 0.020). At 12 months, food assistance was associated with improved food security (-3.49 vs -1.89, P = 0.011) and BMI (0.22 vs -0.67, P = 0.036). Food assistance was associated with improved adherence to monthly clinic visits at both 6 (P < 0.001) and 12 months (P = 0.033).


CONCLUSIONS
Food assistance was associated with improved food security, increased BMI, and improved adherence to clinic visits at 6 and 12 months among people living with HIV in Haiti and should be part of routine care where HIV and food insecurity overlap.
Ivers
Louise C
LC
Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Partners In Health, Boston, Massachusetts, USA.|Biostatistics and Computational Biology, Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA.|General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
Chang
Yuchiao
Y
Biostatistics and Computational Biology, Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA.|General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
Gregory Jerome
J
J
Zanmi Lasante, Cange, Haiti.
Freedberg
Kenneth A
KA
Biostatistics and Computational Biology, Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA.|General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
J Gen Intern Med. 2009 Jan;24(1):14-20
18953617
Curr HIV/AIDS Rep. 2009 Nov;6(4):224-31
19849966
J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):190-5
18769349
J Acquir Immune Defic Syndr. 2009 Nov 1;52(3):342-9
19675463
J Acquir Immune Defic Syndr. 2009 Jun 1;51(2):135-9
19504725
Clin Infect Dis. 2005 Oct 15;41(8):1179-85
16163638
J Gen Intern Med. 2006 Jan;21(1):71-7
16423128
Am J Phys Anthropol. 2008 Feb;135(2):225-32
18046777
JAMA. 2006 Aug 16;296(7):782-93
16905784
Health Rep. 2001 Aug;12(4):11-22
15069808
Clin Infect Dis. 2009 Oct 1;49(7):1096-102
19725790
HIV Med. 2000 Jul;1(3):133-6
11737339
Clin Infect Dis. 2006 Mar 15;42(6):836-42
16477562
PLoS Med. 2007 Oct;4(10):1589-97; discussion 1598
17958460
N Engl J Med. 2004 Jul 1;351(1):78-80
15229312
Bull World Health Organ. 2008 Jul;86(7):559-67
18670668
Clin Infect Dis. 2009 Sep 1;49(5):787-98
19624276
AIDS. 2006 Nov 28;20(18):2355-60
17117022
J Nutr. 2009 Nov;139(11):2132-8
19741201
Clin Infect Dis. 2008 May 15;46(10):1582-8
18419494
JAMA. 2006 Aug 9;296(6):679-90
16896111