Nutrition support for HIV-TB co-infected adults in Senegal, West Africa: A randomized pilot implementation study

PLoS One. 2019 Jul 18;14(7):e0219118. doi: 10.1371/journal.pone.0219118. eCollection 2019.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use
  • Antitubercular Agents / therapeutic use
  • Coinfection / diet therapy*
  • Coinfection / drug therapy
  • Female
  • Food Supply
  • Food, Fortified
  • HIV Infections / diet therapy*
  • HIV Infections / drug therapy
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Nutritional Support* / methods
  • Patient Acceptance of Health Care
  • Pilot Projects
  • Senegal
  • Tuberculosis, Pulmonary / diet therapy*
  • Tuberculosis, Pulmonary / drug therapy

Substances

  • Anti-HIV Agents
  • Antitubercular Agents

Associated data

  • ClinicalTrials.gov/NCT03711721

Grant support

This study was supported by research grant #20150056 awarded to NAB from the Firland Foundation (www.firland.org, Shoreline, WA, USA). GSG has received research grants and support from the US National Institutes of Health, University of Washington, Bill & Melinda Gates Foundation, Gilead Sciences, Alere Technologies, Merck & Co, Inc, Janssen Pharmaceutica, Cerus Corporation, ViiV Healthcare, Bristol-Myers Squibb, and Abbott Molecular Diagnostics. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.