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      Acceptability and use of ready-to-use supplementary food compared to corn–soy blend as a targeted ration in an HIV program in rural Haiti: a qualitative study

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          Abstract

          Background

          Ready-to-use supplementary food (RUSF) is increasingly used as a component of food rations for adults with HIV.

          Methods

          We undertook a qualitative study to evaluate the acceptability and use of peanut-based RUSF compared to corn–soy blend (CSB) among adults living with HIV in rural Haiti who had been enrolled in a prospective, randomized trial comparing the impact of those rations. A total of 13 focus groups were conducted with 84 participants—42 selected from the RUSF arm of the study, and 42 from the CSB arm—using a guide with pre-designated core topics and open-ended questions.

          Results

          We found that RUSF was highly acceptable in terms of taste, preparation, and packaging. Both types of food ration were widely shared inside and outside households, especially with children. However, while CSB was without exception stored with the communal household food supply, RUSF was frequently separated from the household food supply and was more often reserved for consumption by individuals with HIV.

          Conclusions

          RUSF was a highly acceptable food ration that, compared to CSB, was more often reserved for use by the individual with HIV. Qualitative examination of the perceptions, use, and sharing of food rations is critical to understanding and improving the efficacy of food assistance for food-insecure people living with HIV.

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          Most cited references21

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          Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS.

          Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.
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            What's love got to do with it? Explaining adherence to oral antiretroviral pre-exposure prophylaxis for HIV-serodiscordant couples.

            Adherence may be the "Achilles heel" of pre-exposure prophylaxis (PrEP), a promising biomedical approach to HIV prevention. This article presents an explanation of PrEP adherence for African serodiscordant couples derived from qualitative data. Explaining quantitative findings is one way qualitative investigation contributes to research in medicine and public health. This qualitative interview study was nested in the Partners PrEP Study, a phase III randomized trial evaluating oral tenofovir and emtricitabine/tenofovir PrEP to prevent HIV acquisition by HIV-uninfected partners in serodiscordant heterosexual couples. In-depth qualitative interviews were provided by 60 Partners PrEP Study participants in Uganda. Interviews used open-ended questions eliciting information on adherence experiences, barriers, and facilitators. An inductive approach informed by grounded theory methodology was used to analyze study data. The proposed explanation may be summarized as follows. Serodiscordance destabilizes couples, as the HIV-negative partner reacts with anger, fear, and sadness to the implication of infidelity represented by HIV infection. A "discordance dilemma" ensues, as the desire to avoid acquiring HIV and the advantages of preserving the relationship become competing priorities. PrEP is seen as a solution-a means of safeguarding health without ending the relationship. PrEP users benefit from the support of partners, who reinforce adherence. Where discord in the relationship persists, adherence suffers. PrEP adherence in serodiscordant couples may be understood as a function of the desire to reduce risk although preserving a partnered relationship. PrEP use in stable couples may be associated with improved adherence and thus, greater effectiveness.
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              Food insecurity and HIV/AIDS: current knowledge, gaps, and research priorities.

              Food insecurity and HIV/AIDS are intertwined in a vicious cycle that heightens vulnerability to, and worsens the severity of, each condition. We review current knowledge and research priorities regarding the impact of food insecurity on HIV transmission risk and clinical outcomes. Observational studies suggest that food insecurity is associated with increased HIV transmission risk behaviors and decreased access to HIV treatment and care. Among individuals receiving antiretroviral therapy (ART), food insecurity is associated with decreased ART adherence, reduced baseline CD4 cell count, incomplete virologic suppression, and decreased survival. Integration of food security interventions into HIV/AIDS treatment programs is essential to curtail the HIV/AIDS epidemic and improve health and quality of life among those infected. Longitudinal research applying validated measurement tools is needed to better understand the mechanisms through which food insecurity adversely impacts HIV transmission, treatment, and care. Research should compare the effectiveness of various food assistance and livelihood strategies.
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                Author and article information

                Contributors
                abeckett@partners.org
                debbie.humphries@yale.edu
                gjerome@pih.org
                jteng@pih.org
                pulysse@pih.org
                livers@pih.org
                Journal
                AIDS Res Ther
                AIDS Res Ther
                AIDS Research and Therapy
                BioMed Central (London )
                1742-6405
                17 February 2016
                17 February 2016
                2016
                : 13
                : 11
                Affiliations
                [ ]Internal Medicine Residency, Department of Medicine, Brigham & Women’s Hospital, 75 Francis St., Boston, MA 02115 USA
                [ ]Department of Medicine, Boston Children’s Hospital, Boston, MA USA
                [ ]Partners In Health, Boston, MA USA
                [ ]Department of Epidemiology of Microbial Disease, Yale School of Public Health, 60 College Street, Ste 318, New Haven, CT 06510 USA
                [ ]Zanmi Lasante, St. Marc, Haiti
                [ ]Division of Global Health Equity, Brigham & Women’s Hospital, 641 Huntington Avenue, Boston, MA 02115 USA
                [ ]Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
                [ ]Zanmi Lasante, 18A, Santo 18, Croix-des-Bouquets, Haiti
                Article
                96
                10.1186/s12981-016-0096-9
                4757996
                26893605
                8d0b5b8f-a1d0-43f2-a7ec-a464efdf96e3
                © Beckett et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 22 July 2015
                : 8 February 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000862, Doris Duke Charitable Foundation (US);
                Funded by: FundRef http://dx.doi.org/10.13039/100000071, National Institute of Child Health and Human Development (US);
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Infectious disease & Microbiology
                hiv,nutrition,ready-to-use supplementary food
                Infectious disease & Microbiology
                hiv, nutrition, ready-to-use supplementary food

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