title: A qualitative investigation of adherence to nutritional therapy in malnourished adult AIDS patients in Kenya.
abstract: OBJECTIVE
  To understand factors affecting the compliance of malnourished, HIV-positive adults with a nutritional protocol using ready-to-use therapeutic food (RUTF; Plumpy'nut®).
  
  
  METHODS
  Qualitative study using key informant interviews, focus group discussions and direct observations.
  
  
  METHODS
  Ministry of Health HIV/programme supported by Médecins Sans Frontièrs (MSF) in Nyanza Province, Kenya.
  
  
  METHODS
  Adult patients (n 46) currently or previously affected by HIV-associated wasting and receiving anti-retroviral therapy, their caregivers (n 2) and MoH/MSF medical employees (n 8).
  
  
  RESULTS
  Thirty-four out of forty-six patients were receiving RUTF (8360 kJ/d) at the time of the study and nineteen of them were wasted (BMI < 17 kg/m2). Six of the thirteen wasted out-patients came to the clinic without a caregiver and were unable to carry their monthly provision (12 kg) of RUTF home because of physical frailty. Despite the patients' enthusiasm about their weight gain and rapid resumption of labour activities, the taste of the product, diet monotony and clinical conditions associated with HIV made it impossible for half of them to consume the daily prescription. Sharing the RUTF with other household members and mixing with other foods were common. Staff training did not include therapeutic dietetic counselling.
  
  
  CONCLUSIONS
  The level of reported compliance with the prescribed dose of RUTF was low. An improved approach to treating malnourished HIV-positive adults in limited resource contexts is needed and must consider strategies to support patients without a caregiver, development of therapeutic foods more suited to adult taste, specific dietetic training for health staff and the provision of liquid therapeutic foods for severely ill patients.
authors.affiliation: Valid International, 35 Leopold Street, Oxford OX4 1TW, UK. filippo@validinternational.org
authors.forename: Filippo
authors.initials: F
authors.lastname: Dibari
authors.forename: Paluku
authors.initials: P
authors.lastname: Bahwere
authors.forename: Isabelle
authors.initials: I
authors.lastname: Le Gall
authors.forename: Saul
authors.initials: S
authors.lastname: Guerrero
authors.forename: David
authors.initials: D
authors.lastname: Mwaniki
authors.forename: Andrew
authors.initials: A
authors.lastname: Seal
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D015992:Body Mass Index; D017028:Caregivers / Q000193:education; D005260:Female; D017144:Focus Groups; D005526:Food, Formulated; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D010349:Patient Compliance; D010353:Patient Education as Topic; D012944:Social Support; D011795:Surveys and Questionnaires; D013649:Taste; D016896:Treatment Outcome