title: 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.
abstract: 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.
authors.affiliation: 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.
authors.forename: Louise C
authors.initials: LC
authors.lastname: Ivers
authors.affiliation: Biostatistics and Computational Biology, Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA.|General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.affiliation: Zanmi Lasante, Cange, Haiti.
authors.forename: J
authors.initials: J
authors.lastname: Gregory Jerome
authors.affiliation: Biostatistics and Computational Biology, Harvard University Center for AIDS Research, Cambridge, Massachusetts, USA.|General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
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