a1 British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608–1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
a2 Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
a3 International Center for AIDS Care and Treatment Programs (ICAP), Columbia University Mailman School of Public Health, New York, NY, USA
a4 Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
a5 Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
a6 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
Objective To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa.
Design In 2008, we conducted a cross-sectional survey of sites providing antiretroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods.
Setting President's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries.
Subjects A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients.
Results Of the sites under study, 303 (90 %) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98 %, 64 %, 36 % and 31 % of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2·2, 95 % CI 1·1, 4·5). Rural sites (AOR: 2·3, 95 % CI 1·4, 3·8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2·4, 95 % CI 1·4, 4·1). Sites providing ART for >2 years (AOR: 1·6, 95 % CI 1·3, 1·9) and rural sites (AOR: 2·4, 95 % CI 1·4, 4·4) had greater odds of food ration availability.
Conclusions Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.
(Received October 04 2010)
(Accepted April 28 2011)
(Online publication August 02 2011)