Implementation and Impact of a Nutrition Assessment, Counseling and Support program on People Living with HIV in Accra, Ghana.
Sackey, Joachim.
2017
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Abstract: Nutrition
plays an important role in the management of HIV but has not been a routine and widely
accessible part of HIV care in Ghana. To address nutrition-related issues in HIV care
and management, U.S. Agency for International Development (USAID) collaborated with
various National Health Authorities to introduce the Nutrition Assessment, Counseling
and Support (NACS) framework into ... read moreGhana and other countries mostly in Sub-Saharan Africa
to provide nutrition services and "improve the nutritional status of individuals and
populations living with HIV (PLWH) and Tuberculosis". Since the introduction of NACS as
part of Ghana's HIV control program, evaluation of its implementation and impact on
health outcomes has not been carried out, and that is what this thesis sought to do. The
main objective of this thesis was to assess whether NACS was being implemented as
planned and whether it led to a change in nutritional status as measured by body mass
index (BMI), depression, and health related quality of life (HRQol) among PLWH in Accra,
Ghana. Our first specific aim was to evaluate the implementation of NACS and whether the
degree of implementation was associated with BMI among PLWH. Our second aim was to
assess the impact of receiving care at a NACS HIV clinic on changes in BMI in a cohort
of PLWH six months after enrollment into this study. Our final aim was to assess the
impact of receiving care at a NACS designated HIV clinic on changes in depression
symptoms and HRQol in that same cohort of PLWH. To achieve Specific Aim 1, we conducted
a cross-sectional study assessing indicators of NACS implementation in six HIV clinics
(three NACS designated and three non-NACS). We collected HIV clinic level information
and directly observed five counseling sessions in each HIV clinic to ascertain the
presence and content of nutrition counseling and provision of food support. To answer
Specific Aims 2 and 3, we recruited 152 adult PLWH from the six HIV clinics (25 per
clinic) and followed them prospectively for six months with data collected at baseline,
three and six months after recruitment. At each study visit we administered a
questionnaire collecting information on demographics, depression symptoms, and HRQol,
and also measured subjects' weight and height. For the first specific aim, we found poor
implementation of NACS in the NACS designated HIV clinics; no nutrition assessments
other than calculated BMI (in two NACS designated HIV clinics), no nutrition counseling
being performed, and no food support available on site. In addition, a greater score on
the NACS implementation scale was not associated with subjects' BMI. A fifth (20.5%) of
all participants were obese; 26.5% were overweight; and only 3.3% were underweight. For
the second aim, we found that receiving care in a NACS designated HIV clinic did not
predict change in BMI three or six months after enrollment into this study. Further,
NACS implementation score was not associated with changes in BMI, irrespective of
whether the hospital was designated as NACS or non-NACS. For the third aim, we found
that there was no significant difference in depression symptoms and HRQol between
subjects receiving care in a NACS designated HIV clinic and those receiving care in a
non-NACS clinic at three months after enrollment. However, between the three and six
months follow-up, receiving care in a NACS designated HIV clinic was significantly
associated with a reduction in depression symptoms and an increase in HRQol scores. In
summary, our results indicate that the NACS program components, including nutrition
assessments, nutrition counseling, and food support, were not being implemented
appropriately in NACS designated HIV clinics in Accra, Ghana. Although receiving care in
NACS designated HIV clinics was not associated with changes in BMI, the lack of effect
might be largely due to the poor implementation of the NACS program in these clinics.
Receiving care in a NACS designated HIV clinic was associated with reduced depression
symptoms and improved HRQol between three and six months of the follow-up. Such an
impact is unlikely to be attributable to NACS implementation. Future studies are needed
to further investigate factors hindering the implementation of NACS in Ghana and
subsequently evaluate whether NACS represents a simple, cost-effective method to improve
the nutritional status of PLWH living in Ghana. The high proportion of PLWH being
overweight or obese also calls for future NACS programs to incorporate nutrition
counseling or support that can reduce obesity risk in
PLWH.
Thesis (Ph.D.)--Tufts University, 2017.
Submitted to the Dept. of Nutritional Epidemiology.
Advisor: Christine Wanke.
Committee: Beatrice Rogers, and Fang Zhang.
Keyword: Nutrition.read less - ID:
- jq085x79q
- Component ID:
- tufts:20533
- To Cite:
- TARC Citation Guide EndNote
