The impact of a food assistance program on nutritional status, disease progression and food security among people living with HIV in Uganda

The impact of a food assistance program on nutritional status, disease progression and food security among people living with HIV in Uganda

This study contributes needed evidence of the impact of food assistance targeted to PLHIV on their nutritional status and food security outcomes. It is among only a handful of rigorously designed studies
that examine this, and is the first in sub-Saharan Africa, where the overlap of HIV and food insecurity is greatest, to demonstrate impacts on both nutritional status and food security. While policies and programs of food assistance within the context of high HIV and food insecurity are widespread, they are justified on only scant evidence regarding the impacts of such integrated models.
By carrying out the study in a routine program context, and in coordination with one of the largest providers of food assistance in the region, the results are valuable to programmers and have a degree of
external validity they would not have had if the evaluation had altered program design. By restricting initial enrollment to individuals ineligible for ART, based on CD4 counts, and excluding individuals who
subsequently went on ART, this study examined the potential beneficial role of a food and nutrition security intervention during a critical disease stage where CD4 counts were low, but not yet low enough
to meet the eligibility criteria for ART.
While the past few years have seen a dramatic expansion of ART access across sub-Saharan Africa, significant challenges to universal access remain. Food insecurity remains a critical barrier to both access
and adherence to ART. This study demonstrates the benefit of food assistance in the absence of ART, and highlights the potential for food assistance programming to be part of the standard of care for PLHIV in
areas of widespread food insecurity.