Department of Medicine, University of Washington, Seattle, WA, United States of America.
Centre de Santé de Ziguinchor, Ziguinchor, Senegal.
PLoS One. 2019 Jul 18;14(7):e0219118. doi: 10.1371/journal.pone.0219118. eCollection 2019.
Food insecurity can contribute to poor adherence to both tuberculosis treatment and HIV antiretroviral therapy (ART). Interventions that target food insecurity have the potential to increase treatment adherence, improve clinical outcomes, and decrease mortality. The goals of this study were to compare the feasibility, acceptability, and potential impact of implementing two different forms of nutrition support for HIV-TB co-infected adults in the Casamance region of Senegal.
We conducted a randomized pilot implementation study among HIV-TB co-infected adults initiating treatment for TB (ClinicalTrials.gov Identifier: NCT03711721). Subjects received nutrition support in the form of a local food basket or Ready-to-Use Therapeutic Food (RUTF), distributed on a monthly basis for six months.
A total of 178 monthly study encounters were completed by 26 HIV-TB co-infected adults; 14 received food baskets and 12 received RUTF. For both the food basket and RUTF, 100% of subjects obtained the supplement at every study encounter, transferred the supplement from the clinic to their household, and consumed the supplement. The food basket had greater acceptability and was more likely to be shared with members of the household. Adherence to TB treatment and ART exceeded 95%, and all outcomes, including CD4 cell count, hemoglobin, nutritional status, and food security, improved over the study period. All subjects completed TB treatment and were smear negative at treatment completion. The total cost of the local food basket was approximately $0.68 per day versus $0.99 for the RUTF.
The implementation of nutrition support for HIV-TB co-infected adults in Senegal is feasible and may provide an effective strategy to improve adherence, treatment completion, and clinical outcomes for less than 1 USD per day. Further studies to determine the impact of nutrition support among a larger population of HIV-TB co-infected individuals are indicated.
食物不安全可能导致结核病治疗和艾滋病毒抗逆转录病毒疗法（ART）的依从性差。针对食物不安全的干预措施有可能提高治疗依从性、改善临床结果并降低死亡率。本研究的目的是比较在塞内加尔卡萨芒斯地区为艾滋病毒/结核双重感染成年人实施两种不同形式的营养支持的可行性、可接受性和潜在影响。
我们在开始结核病治疗的艾滋病毒/结核双重感染成年人中开展了一项随机试点实施研究（临床试验编号：NCT03711721）。受试者接受了以当地食物篮或即食治疗食品（RUTF）形式提供的营养支持，每月提供一次，为期六个月。
共有 26 名艾滋病毒/结核双重感染成年人完成了 178 次每月的研究接触；14 人接受了食物篮，12 人接受了 RUTF。对于食物篮和 RUTF，100%的受试者每次研究接触都获得了补充剂，将补充剂从诊所转移到家庭中，并消耗了补充剂。食物篮的可接受性更高，更有可能与家庭其他成员分享。结核病治疗和 ART 的依从性超过 95%，所有结果均得到改善，包括 CD4 细胞计数、血红蛋白、营养状况和粮食安全。所有受试者均完成了结核病治疗，在治疗结束时均为痰阴性。当地食物篮的总成本约为每天 0.68 美元，而 RUTF 为每天 0.99 美元。
在塞内加尔为艾滋病毒/结核双重感染成年人提供营养支持是可行的，并且每天不到 1 美元的费用可能是提高依从性、完成治疗和改善临床结果的有效策略。需要进一步研究以确定营养支持对更大规模的艾滋病毒/结核双重感染人群的影响。
