Risk Factors Associated With Achieving Body Mass Index (BMI) Based Normal Nutritional Status Among Persons Living With HIV (PLHIV) that Underwent The Nutrition Assessment, Counseling and Support (NACS) Thrive Study in the Copperbelt and Eastern Provinces of Zambia From 2012-2017 Pubblico
Dualeh, Mushtaq Omar (Spring 2019)
Abstract
Background: The Republic of Zambia is home to one of the highest adult prevalence rates of HIV, currently at 12.4 percent. The Thrive project was implemented in 2012 to promote good nutrition and prevent malnutrition amongst PLHIV. The specific objectives of the Thrive project were: 1) to determine the level of nutritional knowledge, attitudes and practices (KAPs) among PLHIV; 2) understand the trends in BMI of NACS clients, and 3) define the levels of engagement, adherence and retention to care and treatment for PLHIV. There is a strong association of increased access to nutritional counseling and support with HIV treatment.
Methods: This is a secondary data analysis of the Thrive project. The study population (n=969) came from 16 selected health facilities in Copperbelt and Eastern Province, Zambia. Information on nutritional status was abstracted from medical and NACS records throughout the duration of the study, this included baseline and monthly measurements. A structured KAPs questionnaire was administered to PLHIV at the end of the study. The participants used for this analysis were individuals with at least two BMI measures, at baseline and at the third visit. The cohort was then stratified by those with abnormal BMI at baseline, high or low at baseline (n=322). A univariate analysis conducted on potential risk factors, determined variables included in the multivariate analysis. A stepwise logistic regression was used to determine significant findings.
Results: Among the analytic sample, at baseline 241 had low BMI (37.7%) and 81 had high BMI (12.6%). The majority of respondents (60.9%) were previously diagnosed as malnourished at a health facility and most respondents (71.4%) felt their nutrition status had improved over the course of the study. The majority (76.5%) with low BMI at baseline failed to achieve normal nutritional status by their third visit; similarly, the overwhelming majority, 91.4%, of those with high BMI at baseline failed to achieve normal nutritional status by their third visit.
Discussion: Our findings suggest that risk factors significantly associated with failure to reach normal nutritional standing differ between participants with low BMI at baseline and high BMI at baseline.
Table of Contents
ABSTRACT. iv
ACKNOWLEDGEMENTS. vi
CHAPTER I: REVIEW OF LITERATURE. 1
Public Health Burden of HIV/AIDS Worldwide. 1
HIV Burden in Zambia. 1
Malnutrition. 2
Malnutrition and HIV. 3
Food Insecurity. 8
The Case for Concurrent ART and Nutritional Interventions for PLHIV. 10
Nutrition Programs for PLHIV in Zambia. 11
CHAPTER II: MANUSCRIPT. 14
Introduction. 15
Thrive Overview. 15
Methods. 17
Study Population and Setting. 17
Data Collection. 17
Evaluation. 20
Data Management and Coding. 20
Data Analysis. 21
Ethical Considerations. 24
Results. 25
Nutritional Knowledge, Attitudes, Practices. 26
Body Mass Index. 27
Univariate Analysis. 28
Risk Factors Associated with Malnutrition at Baseline. 29
Risk Factors Associated with Failure. 30
Discussion. 33
CHAPTER III: Conclusion and Recommendations. 39
REFERENCES. 43
TABLES AND FIGURES. 47
APPENDIX A: SAS Code. 58
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