The Effect of Community-Based Nutritional Interventions on Children of Women Living With Human Immunodeficiency Virus in Rural India: A 2 × 2 Factorial Intervention Trial

Author:

Shin Sanghyuk S1ORCID,Satyanarayana Veena A2,Ekstrand Maria L34,Carpenter Catherine L56ORCID,Wang Qiao1,Yadav Kartik1,Ramakrishnan Padma7,Pamujula Suresh8,Sinha Sanjeev7,Nyamathi Adeline M1

Affiliation:

1. Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA

2. Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India

3. University of California San Francisco, San Francisco, California, USA

4. St John’s Research Institute, Bangalore, India

5. Department of Epidemiology, University of California Los Angeles, Los Angeles, California, USA

6. UCLA Center for Human Nutrition, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA

7. Department of Medicine, All India Institute of Medical Sciences, Delhi, India

8. A.C. Subba Reddy Government Medical College, Nellore, India

Abstract

Abstract Background Malnutrition is a common clinical concern among children in low-income communities affected by human immunodeficiency virus (HIV). We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India. Methods We assigned women living with HIV and their child (oldest 3–8 years) to 1 of 4 programs: (1) community-based HIV care program, (2) program 1 + nutrition education, (3) program 1 + food supplement, and (4) all elements of programs 1–3. Study data were collected at baseline and months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4+ T-cell counts (children with HIV only). Results Overall, 600 mother–child pairs were enrolled (150/group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in program 4 had higher weight gain than those in programs 1, 2, and 3 at all time points (adjusted P < .001). We found a higher increase in CD4+ T cells across all time points among participants in programs 3 and 4 compared with program 1 (adjusted P < .001). Factorial analysis suggested a synergistic effect of combining nutrition education and food supplements for weight gain but not for increase in CD4+ T cells. Conclusions A combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4+ T cells, and such interventions can be integrated into HIV-care programs in low-income settings.

Funder

National Institute of Mental Health

National Institute of Allergy and Infectious Diseases

National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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