title: A pre-post pilot study of peer nutritional counseling and food insecurity and nutritional outcomes among antiretroviral therapy patients in Honduras.
abstract: BACKGROUND
  Food insecurity and poor nutrition are key barriers to anti-retroviral therapy (ART) adherence. Culturally-appropriate and sustainable interventions that provide nutrition counseling for people on ART and of diverse nutritional statuses are needed, particularly given rising rates of overweight and obesity among people living with HIV (PLHIV).
  
  
  METHODS
  As part of scale-up of a nutritional counseling intervention, we recruited and trained 17 peer counselors from 14 government-run HIV clinics in Honduras to deliver nutritional counseling to ART patients using a highly interactive curriculum that was developed after extensive formative research on locally available foods and dietary patterns among PLHIV. All participants received the intervention; at baseline and 2 month follow-up, assessments included: 1) interviewer-administered, in-person surveys to collect data on household food insecurity (15-item scale), nutritional knowledge (13-item scale), dietary intake and diversity (number of meals and type and number of food groups consumed in past 24 hours); and 2) anthropometric measures (body mass index or BMI, mid-upper arm and waist circumferences). We used multivariable linear regression analysis to examine changes pre-post in food insecurity and the various nutritional outcomes while controlling for baseline characteristics and clinic-level clustering.
  
  
  RESULTS
  Of 482 participants at baseline, we had complete follow-up data on 356 (74%), of which 62% were women, median age was 39, 34% reported having paid work, 52% had completed primary school, and 34% were overweight or obese. In multivariate analyses adjusting for gender, age, household size, work status, and education, we found that between baseline and follow-up, household food insecurity decreased significantly among all participants (β=-0.47, p<.05) and among those with children under 18 (β=-1.16, p<.01), while nutritional knowledge and dietary intake and diversity also significantly improved, (β=0.88, p<.001; β=0.30, p<.001; and β=0.15, p<.001, respectively). Nutritional status (BMI, mid-arm and waist circumferences) showed no significant changes, but the brief follow-up period may not have been sufficient to detect changes.
  
  
  CONCLUSIONS
  A peer-delivered nutritional counseling intervention for PLHIV was associated with improvements in dietary quality and reduced food insecurity among a population of diverse nutritional statuses. Future research should examine if such an intervention can improve adherence among people on ART.
authors.affiliation: Health Program, RAND Corporation, Santa Monica, California, United States of America.
authors.forename: Kathryn P
authors.initials: KP
authors.lastname: Derose
authors.affiliation: Pardee RAND Graduate School, Santa Monica, California, United States of America.
authors.forename: Melissa
authors.initials: M
authors.lastname: Felician
authors.affiliation: Health Program, RAND Corporation, Santa Monica, California, United States of America.
authors.forename: Bing
authors.initials: B
authors.lastname: Han
authors.affiliation: Department of Medicine, Division of HIV/AIDS, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Kartika
authors.initials: K
authors.lastname: Palar
authors.affiliation: Honduran Country Office, United Nations World Food Program, Tegucigalpa, Honduras.
authors.forename: Blanca
authors.initials: B
authors.lastname: Ramírez
authors.affiliation: Regional Office for Latin America and the Caribbean, United Nations World Food Program, Panama City, Panama.
authors.forename: Hugo
authors.initials: H
authors.lastname: Farías
authors.affiliation: Health Program, RAND Corporation, Santa Monica, California, United States of America ; Hospital Infantil de México Federico Gómez, Mexico City, Mexico.
authors.forename: Homero
authors.initials: H
authors.lastname: Martínez
keywords: HIV; food insecurity; lay health workers; nutritional counseling