title: Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries.
abstract: OBJECTIVE
  To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa.
  
  
  METHODS
  In 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods.
  
  
  METHODS
  President's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries.
  
  
  METHODS
  A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients.
  
  
  RESULTS
  Of the sites under study, 303 (90 %) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98 %, 64 %, 36 % and 31 % of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2.2, 95 % CI 1.1, 4.5). Rural sites (AOR: 2.3, 95 % CI 1.4, 3.8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2.4, 95 % CI 1.4, 4.1). Sites providing ART for >2 years (AOR: 1.6, 95 % CI 1.3, 1.9) and rural sites (AOR: 2.4, 95 % CI 1.4, 4.4) had greater odds of food ration availability.
  
  
  CONCLUSIONS
  Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. aanema@cfenet.ubc.ca
authors.forename: Aranka
authors.initials: A
authors.lastname: Anema
authors.forename: Wendy
authors.initials: W
authors.lastname: Zhang
authors.forename: Yingfeng
authors.initials: Y
authors.lastname: Wu
authors.forename: Batya
authors.initials: B
authors.lastname: Elul
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Wafaa
authors.initials: W
authors.lastname: El Sadr
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D018529:Nutritional Support / Q000706:statistics & numerical data*; D010349:Patient Compliance; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents