Sue & Bill Gross School of Nursing, University of California, Irvine, CA.
School of Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):429-438. doi: 10.1097/QAI.0000000000002044.
Women living with HIV (WLH) in rural communities face challenges to obtaining treatment and accurate disease-related information. Nutritional deficits exacerbate disease progression.
WLH were recruited from primary health centers in rural India.
A quasi-experimental trial of a comprehensive Accredited Social Health Activist (Asha)-supported intervention compared 4 distinct Asha-based programs [(1) standard education (SE) alone; (2) nutrition education (+NE); (3) nutrition supplements (+NS); or (4) nutrition education and nutrition supplements (+NENS)] on key disease and nutrition-related outcomes [CD4 count, body mass index (BMI), serum albumin, and hemoglobin]. Assessments occurred at baseline, and months 6 (immediately after intervention), 12, and 18. Multilevel modeling examined effects of program (group) over time.
Among 600 WLH enrolled (n = 150 per arm), mean age, CD4 count, and BMI (kg/m) were 34.31, 447.42, and 20.09, respectively, at baseline. At 18-month follow-up, program 4 (+NENS) experienced greatest improvements in CD4 counts compared with program 1 (+SE) [adjusted difference = 223.81, 95% confidence interval (CI): 170.29 to 277.32]. For BMI, programs 3 (+NS; adjusted difference = 2.33, 95% CI: 1.39 to 3.26) and 4 (+NENS; adjusted difference = 2.14, 95% CI: 1.17 to 3.12) exhibited greater gains compared with program 1 (+SE). Programs 3 and 4 were not significantly different from each other (adjusted difference = -0.18, 95% CI: -1.12 to 0.76). Hemoglobin and serum albumin also improved over time; program 4 (+NENS) exhibited the greatest gains.
A low-cost Asha-supported behavioral and nutritional intervention improved outcomes for WLH. Gains were sustained at 18-month follow-up. Similar approaches may help improve HIV and other infectious disease-related outcomes in vulnerable populations.
农村社区的 HIV 感染者（WLH）在获得治疗和准确的疾病相关信息方面面临挑战。营养不足会加剧疾病的进展。
在印度农村的初级保健中心招募了 WLH。
一项针对综合认可社会卫生活动家（Asha）支持的干预措施的准实验性试验，比较了 4 种不同的 Asha 为基础的方案[（1）单独的标准教育（SE）；（2）营养教育（+NE）；（3）营养补充剂（+NS）；或（4）营养教育和营养补充剂（+NENS）]对关键疾病和营养相关结果[CD4 计数、体重指数（BMI）、血清白蛋白和血红蛋白]的影响。评估在基线时、干预后 6 个月（立即）、12 个月和 18 个月进行。多水平模型检查了方案（组）随时间的影响。
在纳入的 600 名 WLH 中（每组 150 名），平均年龄、CD4 计数和 BMI（kg/m）分别为 34.31、447.42 和 20.09，在基线时。在 18 个月的随访中，与方案 1（+SE）相比，方案 4（+NENS）的 CD4 计数改善最大[调整差异=223.81，95%置信区间（CI）：170.29 至 277.32]。对于 BMI，方案 3（+NS；调整差异=2.33，95%CI：1.39 至 3.26）和 4（+NENS；调整差异=2.14，95%CI：1.17 至 3.12）与方案 1（+SE）相比，获得的收益更大。方案 3 和 4 之间没有显著差异（调整差异=-0.18，95%CI：-1.12 至 0.76）。血红蛋白和血清白蛋白也随时间而改善；方案 4（+NENS）的改善最大。
一项低成本的 Asha 支持的行为和营养干预措施改善了 WLH 的结果。在 18 个月的随访中仍保持获益。类似的方法可能有助于改善弱势人群的 HIV 和其他传染病相关结果。
