A program that provided healthy food and nutrition counseling for people with HIV resulted in fewer hospitalizations, better adherence to treatment, and improvements in mental and physical health, study results show. It was published in the Journal of Infectious Diseases.
“When medically tailored meals and groceries combined with nutrition education, hospitalizations decreased, mental health and medication adherence improved, and unprotected sexual intercourse decreased among people with HIV at high risk for food insecurity,” the study authors concluded. “These findings [tailored food programs] “Improving multiple areas of health for people with HIV and reducing health care costs through reduced use of health services.”
It is well known that a nutritious diet It is key to good health, but many people have little knowledge about good nutrition and limited access to affordable healthy foods. Inconsistent access to healthy foods is recognized as a key determinant of poor health among people with HIV, and support for a “food is medicine” approach is growing.
In the United States, food support for people with HIV, the Supplemental Nutrition Assistance Program (“food stamps”), and the Ryan White HIV/AIDS program are an “interconnected piece” of government support, including nonprofit organizations and community-based programs. consists of “work”. Kartika Palar, PhD, of the University of California San Francisco, and colleagues noted church food pantries and soup kitchens as backdrops.
“Traditional nutrition safety net approaches focus on preventing hunger and reducing economic hardship, but can sometimes lead to unintended consequences that harm health, such as providing foods high in salt or sugar,” they wrote. The food-is-medicine approach, by contrast, “has the potential to address the twin goals of improving food safety and health.”
Previous studies have found food insecurity in rich countries to be associated with higher rates of depression, anxiety and other mental health problems, increased risk of HIV and other sexually transmitted infections (STIs), poorer adherence to antiretroviral therapy, higher viral load, lower CD4 cell count and increased death. rate. However, there have been no previous randomized trials of medically tailored food programs for HIV-positive people.
Palar’s team conducted a study to evaluate results among its existing customers. Project Open Hand is a San Francisco-based nonprofit organization that provides food assistance to people with chronic diseases. The CHEFS-HIV study (NCT03191253), conducted in 2016-2017, included approximately 200 low-income people living with HIV. The study compared 93 clients randomly assigned to participate in a special meal program with 98 clients who received standard meal services.
Most participants were middle-aged men (mean age 55) and had been living with HIV for an average of 22 years. About a third were white, a quarter were black, and about 10% were Latino. At baseline, 39% had uncontrolled HIV; this rate was higher than the citywide rate. Many had comorbidities including diabetes, hypertension, and cardiovascular disease; mental health diagnoses and substance use were common. Median income was approximately $1,000 per month, and more than 60% reported food insecurity. Participants were required to have the ability to store and reheat perishable foods; this likely excluded some unsheltered homeless people.
People in the intervention group were given medically appropriate meals and groceries specifically designed to support their health (either 14 frozen ready meals or seven meals and groceries each week) plus an additional bag of food to meet their nutritional needs. They also attended three group nutrition education classes and two individual nutrition counseling sessions led by a registered dietitian. Those in the control group received standard weekly meals and groceries (enough for one or two meals a day) and met briefly with a dietitian every six months. Food can be delivered if customers cannot pick it up. Health, nutrition, and behavioral outcomes were assessed at baseline and six months later.
At six months, almost 90% of participants in both groups remained in the study. People in the intervention group reported less food insecurity and consumed less fatty foods, but there was no difference in reported fruit and vegetable consumption. People in the program were 89% less likely to be hospitalized, and researchers estimated that the intervention could reduce hospitalization costs by $178,781. People who received enhanced food services were also less likely to report depression, unprotected sex, and treatment adherence rates below 90%. Viral suppression rates improved in both groups, but there was no significant difference between them. Despite these positive results, there was no significant difference in reported health-related quality of life.
“Six-month CHEFS-HIV intervention paired with an intensive community-based program [medically tailored meals and groceries] Registered dietitian-led nutrition education did not impact HIV viral pressure or health-related quality of life, the study authors noted. “But it has increased food security and [antiretroviral therapy] compliance and reduced depressive symptom severity, unprotected sexual intercourse, and overnight hospitalizations compared to controls.”
The researchers suggested that the decrease in unprotected sex may have occurred because addressing food insecurity reduced the need to engage in transactional sex or succumbed to pressure to have unprotected sex to secure food resources. “Therefore, medically tailored food programs may contribute to population efforts to reduce STIs by reducing unprotected sexual intercourse among individuals where food insecurity affects sexual decision-making,” they wrote.
The researchers hypothesized that differences between the groups may have diminished because both groups received groceries and groceries. The effect would likely be stronger if the intervention group was compared with individuals who received no food assistance. Regarding viral suppression, the majority of participants in both groups had their HIV under control at baseline and Getting to Zero initiative Efforts to improve citywide viral suppression rates began around the same time.
“While suppression of viral load is critical for the health of people with HIV and for reducing HIV transmission, social factors associated with food insecurity are often strong contributors to emergency room visits, hospitalizations, and death in San Francisco,” the researchers wrote. “These factors may explain the reduced likelihood of hospitalization with the intervention, despite having no effect on viral suppression.”
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