AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #357 - Barriers to nutrition management among people living with HIV on antiretroviral therapy
Authors: Presenting Author: Ms Julie Maertens - Colorado State University
Additional Authors: Ms Jennifer Harman,
Aim: HIV attacks and impairs the body’s natural defense system against disease and infection, in part through depletion of nutrients that are implicated in malnutrition and weight loss. Additionally, long-term use of ARV medications can lead to the development of insulin resistance and related metabolic complications such as impaired glucose tolerance and dyslipidemia. Many of these nutritional problems can be managed through nutrition education and intervention, thus improving HIV patients’ quality of life. No wide scale evaluation of HIV patients’ access or adherence to nutrition intervention exists; however, there are potential barriers to both receiving and following nutrition advice from healthcare providers. The current study employed a qualitative approach in an effort to identify such barriers.
Method / Issue: An online questionnaire among HIV healthcare providers, along with focus groups and semi-structured interviews among patients living with HIV at three healthcare settings in Colorado were utilized for data collection. In accordance with an Interpretative Phenomenological Analysis approach, four stages of data analysis were undertaken to identify patterns, trends, and themes that emerged and developed from participants’ responses. The analysis used questionnaire data, and transcripts derived from individual and focus group interviews to describe healthcare providers’ and patients’ experiences of barriers to HIV-related nutrition management.
Results / Comments: Healthcare providers thought that nutrition education was important in the management of HIV, and reported that they attempted to give well-rounded and consistent education to patients. They were, however, limited in the amount of education and intervention they could provide based on a lack of time and in-house referral services, and the co-occurrence of multiple illnesses among patients that demanded time and energy during appointments. HIV-positive patients who were interviewed individually or via focus groups reported that they felt their primary healthcare providers delivered a fair amount of applicable dietary advice, and said they thus tried to manage diet as best they could by monitoring the safety of their food and maintaining a balanced diet low in fat, salt, and processed sugars. Patients were limited in their ability to optimally manage their diet based on financial considerations and transportation available for acquiring food, side effects associated with ARV medications, and their own cooking and meal planning skills. All patients said they would participate in the opportunity to learn more specific nutrition management techniques (e.g., cooking, shopping, balancing food with illness) if education were available and accessible.
Discussion: The nature of the barriers identified in the current study suggested that a systems approach to optimizing nutrition management may be an appropriate future direction of action. At the healthcare provider level, nutrition screening, dissemination of handouts or toolkits, and development of innovative programs that provide nutrition education and build patient skills may be useful. At the organization level, clinics that serve HIV-positive patients may also build stronger networks with programs in the local community that address issues related to food insecurity in order to provide links to resources for eligible individuals.
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