制定试点干预措施以满足拉丁美洲和加勒比地区艾滋病毒感染者的粮食不安全和营养需求：采用形成性研究的机构间方法。
Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research.
作者信息
Derose Kathryn P, Palar Kartika, Farías Hugo, Adams Jayne, Martínez Homero
机构信息
1 RAND Corporation, Santa Monica, CA, USA.
2 Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
出版信息
Food Nutr Bull. 2018 Dec;39(4):549-563. doi: 10.1177/0379572118809302. Epub 2018 Nov 19.
BACKGROUND
Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC).
OBJECTIVE
To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy.
METHODS
Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects.
RESULTS
Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists.
CONCLUSION
High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.
背景
粮食不安全和营养不良给艾滋病毒管理带来挑战，但拉丁美洲和加勒比地区（拉加地区）在此方面的研究较少。
目的
评估拉加地区多个国家的艾滋病毒感染者（PLHIV）的粮食不安全和营养不良水平，以为试点项目和政策提供依据。
方法
通过机构间合作，我们收集了玻利维亚、洪都拉斯和多米尼加共和国（DR；N = 400）在艾滋病毒诊所就诊的成年人的社会人口统计学、家庭粮食安全、人体测量学和常见食用食物的数据，并将结果用于试点项目。
结果
大多数艾滋病毒感染者家庭粮食不安全程度为中度或重度（玻利维亚为61%，洪都拉斯为71%，多米尼加共和国为68%）。超重和肥胖也非常普遍，尤其是在女性中（41%-53%的人体质量指数≥25）。高体脂也很普遍，范围在36%至59%之间。在主要食物中，水果和蔬菜匮乏。针对各国的试点项目将因地制宜的营养咨询与每月家庭食物配给、与创收项目的联系或城市菜园相结合。营养咨询最初由专业人员进行，后来由于缺乏营养师而改为由同伴咨询师进行。
结论
拉加地区艾滋病毒感染者中高水平的粮食不安全和超重具有重要影响，因为先前针对艾滋病毒感染者粮食不安全的干预措施主要集中在体重过轻和消瘦方面。形成性研究和部门间合作促成了因地制宜的营养材料和干预措施，增强了当地能力，并有助于将营养指南纳入政策和实践。解决资源匮乏地区的人力资本限制并制定补充战略是关键建议。
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