Impact of food support on food security and body weight among HIV antiretroviral therapy recipients in Honduras: a pilot intervention trial

Abstract

Optimal strategies to improve food security and nutrition for people living with HIV (PLHIV) may differ in settings where overweight and obesity are prevalent and cardiovascular disease risk is a concern. However, no studies among PLHIV have investigated the impact of food support on nutritional outcomes in these settings. We therefore assessed the effect of food support on food insecurity and body weight in a population of PLHIV with high prevalence of overweight and obesity. We implemented a pilot intervention trial in four government-run HIV clinics in Honduras. The trial tested the effect of a monthly household food ration plus nutrition education (n = 203), compared to nutrition education alone (n = 197), over 12 months. Participants were clinic patients receiving antiretroviral therapy (ART). Assessments were obtained at baseline, 6 and 12 months. Primary outcomes for this analysis were food security, using the validated Latin American and Caribbean Food Security Scale and body weight (kg). Thirty-one percent of participants were overweight (22%) or obese (8%) at baseline. At 6 months, the probability of severe food insecurity decreased by 48.3% (p < 0.01) in the food support group, compared to 11.6% in the education-only group (p < 0.01). Among overweight or obese participants, food support led to average weight gain of 1.13 kg (p < 0.01), while nutrition education alone was associated with average weight loss of 0.72 kg (p < 0.10). Nutrition education alone was associated with weight gain among underweight and normal weight participants. Household food support may improve food security but not necessarily nutritional status of ART recipients above and beyond nutrition education. Improving nutritional tailoring of food support and testing the impact of nutrition education should be prioritized for PLHIV in Latin America and similar settings.

Keywords:

• food security
• obesity
• food support
• antiretroviral therapy
• Latin America

Acknowledgments

We thank the study coordinator, Blanca Ramírez, and the interviewers for their hard work and dedication in the field. Sheri Weiser (UCSF) provided critical feedback on earlier versions of this paper. Most importantly, we offer deep appreciation to the study participants who gave so generously of their time and personal information.

Additional information

Funding

This work was funded by the National Institutes of Mental Health (NIMH) [grant number R34MH084675] (PI: Dr. Martinez). Dr. Palar received dissertation support from the Pardee Dissertation Award (RAND) and postdoctoral salary support from the Agency for Healthcare Research and Quality (AHRQ) [grant number T32HS00046]. The contents of this paper are solely the responsibility of the authors and do not represent the official views of NIMH or AHRQ.