Improving ART Adherence Through Urban Gardening and Peer Nutritional Counseling in the Dominican Republic

多米尼加共和国通过城市园艺和同伴营养咨询提高 ART 依从性

• 批准号: 9334938
• 负责人: Kathryn Pitkin Derose
• 金额: $ 25.16万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-18 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9334938
• 关键词: AIDS/HIV problem; Address; Adherence; Africa South of the Sahara; Agriculture; Body fat; California; Caribbean region; Caring; Clinic; Communities; Counseling; Country; Data; Dietary Intervention; Dietary Practices; Dominican; Dominican Republic; Education; Educational Curriculum; Effectiveness; Enrollment; Evaluation; Feeling; Food; Food Supplementation; Fostering; Gardenal; Goals; HIV; HIV therapy; Health; Household; Intervention; Latin America; Lead; Learning; Mediator of activation protein; Mentorship; Nutritional; Nutritional status; Nutritive Value; Obesity; Overweight; Participant; Patients; Pharmaceutical Preparations; Phase; Prevalence; Production; Protocols documentation; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Resources; San Francisco; Site; Social support; Training; Underweight; United Nations; Universities; Viral Load result; Work; antiretroviral therapy; arm; food security; good diet; improved; intervention effect; multi-component intervention; nutrition; nutrition education; peer; peer support; peri-urban; power analysis; primary outcome; programs; secondary outcome; social; social stigma; therapy adherence; treatment as usual; virology

In recent years, access to antiretroviral therapy (ART) for HIV has increased dramatically in Latin America and the Caribbean (LAC) and in particular in the Dominican Republic (DR); however, food insecurity and poor nutrition have emerged as barriers to ART utilization and adherence among people living with HIV (PLHIV), especially in low-resource settings. Our pilot work in the DR found that 68% of PLHIV report moderate or severe food insecurity. Most programs aimed at addressing food insecurity among PLHIV in low-resource settings have involved providing food supplementation, with positive results; however, such efforts are typically not sustainable. Further, most interventions focus primarily on PLHIV who are underweight, while overweight and obesity are also a growing concern. Sustainable approaches that increase access to food and also promote balanced nutrition among PLHIV are needed. Urban gardening together with peer nutritional counseling represents a potential solution. The purpose of this three-year study is to develop, implement, and evaluate the feasibility, acceptability, and preliminary effectiveness of a culturally appropriate, multi-component intervention that targets food insecurity and nutritional health with the ultimate goal of improving ART adherence and virologic suppression for PLHIV in the DR. The specific aims are to: (1) Use formative research on dietary patterns and locally available foods, together with our preliminary research on nutritional counseling and urban gardening, to develop a multi-component nutrition intervention to address food insecurity among PLHIV that integrates culturally-appropriate, peer-led nutritional education with a sustainable urban garden component; (2) Evaluate the feasibility, acceptability and preliminary effectiveness of urban gardening plus peer nutritional counseling on improving our primary outcomes (HIV care retention, ART adherence, and virologic suppression) in both the short (month 6) and longer terms (month 12); and (3) Explore the preliminary intervention effects on potential mediators (food security, nutritional status, internalized HIV stigma, and social support), which are secondary outcomes. The proposed study involves a partnership among researchers from RAND, University of California San Francisco (UCSF) and the Universidad Autónoma de Santo Domingo and other local partners, including program staff from the United Nations World Food Program (WFP), the Dominican Ministry of Agriculture, and the Dominican National HIV/AIDS Council. It builds on our previous work elsewhere in LAC and established relationships between RAND, WFP, and local partners in the DR. As one of the first studies to develop a sustainable food production approach with peer nutrition counseling among PLHIV, key products will include: 1) an easy-to-use peer nutritional counseling curriculum and urban gardens training materials; 2) pilot data on the feasibility, acceptability, and effects of our intervention on primary outcomes and potential mediators; and 3) if results are promising, an R01 application to conduct a fully- powered cluster RCT that examines effects across a larger number of clinics in the DR.

近年来，拉丁美洲获得抗逆转录病毒治疗 (ART) 的机会急剧增加， 然而，加勒比地区（LAC），特别是多米尼加共和国（DR），粮食不安全和贫困； 营养已成为艾滋病毒感染者（PLHIV）利用和坚持抗逆转录病毒治疗的障碍， 特别是在资源匮乏的地区，我们在多米尼加共和国的试点工作发现，68% 的艾滋病毒感染者报告为中度或中度感染。 大多数旨在解决资源匮乏地区艾滋病毒感染者粮食不安全问题的计划。 一些环境涉及提供食物补充剂，但这些努力通常都取得了积极成果； 此外，大多数干预措施主要针对体重过轻和体重过重的艾滋病毒感染者。 肥胖也是一个日益令人关注的问题，以增加食物的获取和获取的可持续方法。 需要促进艾滋病毒感染者的均衡营养，同时进行城市园艺和同伴营养。 这项为期三年的研究的目的是开发、实施和实施咨询。 评估文化上适当的、多组成部分的可行性、可接受性和初步有效性 针对粮食不安全和营养健康的干预措施，最终目标是改善抗病毒治疗 DR 中 PLHIV 的依从性和病毒学抑制 具体目标是： (1) 使用形成性研究。 关于饮食模式和当地可用食物的信息，以及我们对营养咨询的初步研究 和城市园艺，制定多成分营养干预措施，以解决粮食不安全问题 将适合文化、同伴主导的营养教育与可持续城市花园相结合的艾滋病毒感染者 （2）评估城市园林+的可行性、可接受性和初步效果。 同伴营养咨询，以改善我们的主要结果（艾滋病毒护理保留、抗逆转录病毒治疗依从性和 病毒学抑制）在短期（第 6 个月）和长期（第 12 个月）；以及 (3) 探索初步结果； 干预对潜在中介因素（粮食安全、营养状况、内化的艾滋病毒耻辱和社会 支持），这是次要成果，拟议的研究涉及来自研究人员的合作。 兰德公司、加州大学旧金山分校 (UCSF) 和圣多明各自治大学 其他当地合作伙伴，包括联合国世界粮食计划署 ​​(WFP) 的项目工作人员、 多米尼加农业部和多米尼加国家艾滋病毒/艾滋病委员会 它建立在我们以前的基础上。 在拉丁美洲和加勒比地区的其他地方工作，并在兰德公司、粮食计划署和刚果民主共和国的当地合作伙伴之间建立了关系。 首批研究之一，旨在制定可持续粮食生产方法，并在其中提供同伴营养咨询 艾滋病病毒感染者的主要产品将包括：1）易于使用的同伴营养咨询课程和城市花园 培训材料；2) 关于我们干预措施的可行性、可接受性和效果的试点数据 结果和潜在的中介因素；以及 3) 如果结果有希望，则提交 R01 申请以进行全面的 动力集群随机对照试验，检查 DR 中大量诊所的效果。