一项针对印度农村地区 HIV 阳性艾滋病女性患者的基于社区的干预措施对 HIV 和营养结局影响的随机对照试验：6 个月随访结果
Randomized controlled trial of a community-based intervention on HIV and nutritional outcomes at 6 months among women living with HIV/AIDS in rural India.
机构信息
University of California, Irvine, Irvine.
University of California, Los Angeles, Los Angeles.
出版信息
AIDS. 2018 Nov 28;32(18):2727-2737. doi: 10.1097/QAD.0000000000002016.
OBJECTIVE
To assess the impact of nurse-led Asha (Accredited Social Health Activist)-support behavioral and nutritional intervention among women living with HIV/AIDS (WLH/A) in rural India.
DESIGN
Cluster randomized controlled trial.
METHODS
Sixteen Primary Health Centers serving WLH/A in Andhra Pradesh were grouped into four regional clusters that were randomly allocated into one of four arms. All four groups included Asha-support and consisted of: Asha-support only (control group); nutrition education; nutrition supplementation; and the combination of supplementation and education. Differences between baseline and 6-month follow-up for key physiological outcomes (BMI, CD4 cell count) were analyzed using factorial mixed models that accounted for geographic clustering.
RESULTS
At 6 months, all groups improved CD4 cell count: Asha only [mean difference score (D) = 343.97, standard deviation (SD) = 106.94], nutrition education (D = 356.15, SD = 0.69), nutrition supplement (D = 469.66, SD = 116.0), and nutrition supplement and education (D = 530.82, SD = 128.56). In multivariable models, Asha-support and nutrition, and Asha-support and nutrition supplement interventions demonstrated independent significant improvements in CD4 cell count; the interaction term was significant [estimate = 529.9; 95% confidence interval (CI) 512.0, 547.8; P = 0.006]. BMI also increased for all groups: Asha only (D = 0.95, SD = 0.82), Asha and nutrition education (D = 1.28, SD = 0.53), Asha and nutrition supplement (D = 2.38, SD = 0.60), nutrition supplement, and nutrition supplement and education (D = 2.72, SD = 0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (estimate = 0.27; 95% CI = 2.5, 2.7; P = 0.80).
CONCLUSION
Interventions supported by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.
目的
评估在印度农村地区，由护士主导的 Asha（经认证的社会卫生活动家）支持的行为和营养干预对艾滋病毒/艾滋病（HIV/AIDS）妇女的影响。
设计
整群随机对照试验。
方法
在安得拉邦，有 16 个初级保健中心为 HIV/AIDS 妇女提供服务，将这些中心分为四个区域集群，随机分配到四个臂中。所有四个组都包括 Asha 支持，包括：仅 Asha 支持（对照组）；营养教育；营养补充；补充和教育的结合。使用考虑到地理聚类的因子混合模型分析关键生理结果（BMI、CD4 细胞计数）的基线和 6 个月随访之间的差异。
结果
在 6 个月时，所有组的 CD4 细胞计数都有所改善：Asha 仅（平均差值评分（D）=343.97，标准差（SD）=106.94），营养教育（D=356.15，SD=0.69），营养补充（D=469.66，SD=116.0），营养补充和教育（D=530.82，SD=128.56）。在多变量模型中，Asha 支持和营养以及 Asha 支持和营养补充干预对 CD4 细胞计数的改善具有独立的显著意义；交互项具有统计学意义[估计值=529.9；95%置信区间（CI）512.0，547.8；P=0.006]。所有组的 BMI 也都有所增加：Asha 仅（D=0.95，SD=0.82），Asha 和营养教育（D=1.28，SD=0.53），Asha 和营养补充（D=2.38，SD=0.60），营养补充和营养补充和教育（D=2.72，SD=0.84）。营养补充和营养教育对 BMI 有独立影响；交互项不具有统计学意义（估计值=0.27；95%CI=2.5，2.7；P=0.80）。
结论
由社区工作者支持的干预措施在改善生理结果方面是有效的，并且可能有助于满足印度弱势 HIV/AIDS 妇女的关键医疗保健需求。
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