PROVISION OF CASH OR FOOD TO PATIENTS INITIATING ANTIRETROVIRAL THERAPY CONFERS SIMILAR AND POSITIVE EFFECTS IN IMPROVING NUTRITION AND

HEALTH OVER AN EIGHT MONTH PERIOD

Kawana MB , Mofu JM , Siamusantu W , Kabwe FK , Bwalya BB , Chirwa KH , Goulden J , Banda L , Masi
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National Food and Nutrition Commission of Zambia. CARE International Zambia

BACKGROUND The overall objective of the study, was to understand which transfer mechanism (cash or food) ensures adequate nutrition improvement for those initiating ART treatment, and increases adherence to AntiRetroviral Treatment (ART) in a more effective way METHODS HIV positive individuals initiating ART (both male and female aged 18 to 55 years) were randomly allocated, using computer-generated random numbers, to two treatment groups (cash and food), at St. Francis Mission Hospital in Katete District, Eastern Province, and given a food basket or its cash equivalent monthly, for 8 months.

RESULTS
Body Mass Index increased significantly from baseline to post assessment (p-value <0.001) in both treatment groups. There was no significant differences between the two treatment groups in the levels of improvements (p-value = 0.711). Mean Household Dietary Diversity Score (HDDS) for households on cash transfer increased from 5.5 to 6.5, compared to those on food transfer whose HDDS increased from 5.1 to 6.4, and the increase was statistically significant (p-value = 0.001). More than 95 percent of the study clients in both treatment groups had good adherence. At the end of the intervention study, clients on cash and food transfer had 100 percent and 99 percent adherence status respectively. Clients adherence to treatment was independent of the transfer type (p-value = 1.000). Increase in mean CD4 count over the intervention period was also highly significant (p-value < 0.001) in both treatment groups, but there were no significant differences in the effects of the interventions between the treatment groups (p-value = 0.521). Average monthly income increased for both cash and food clients, but this was not statistically significant (p-value = 0.168), and there was no significant difference in income between the two treatment groups (p-value = 0.802).

1 NUTRITION STATUS, BY BODY MASS INDEX

Baseline (N=310) Nutrition Status n Severe Underweight Moderate Underweight Normal Overweight Obese Total 7 35 103 8 2 155 Cash % 4.5 22.6 66.5 5.2 1.3 100 N 4 29 106 11 2 152 Food % 2.6 19.1 69.7 7.2 1.3 100 n 1 9 109 13 3 135 Cash % 0.7 6.7 80.7 9.6 2.2 100 n 2 16 95 17 1 131 Post (N=266) Food % 1.5 12.2 72.5 13 0.8 100

DISTRIBUTION OF CD4 COUNT, BY GROUP

Baseline Cash Food % 47.9 48.5 3.6 100 N 77 84 10 171 % 45 49.1 5.8 100 n 19 51 77 147 Cash % 13.9 34.7 52.4 100 n 24 47 76 147 Post Food % 16.3 32 51.7 100

CD4 Category CD4 Below 200 cells/L CD4 Between 200 350 cells/L CD4 Above 350 cells/L Total

n 80 81 6 167

EFFECT OF INTERVENTION ON CD4 COUNT

3 MEAN HOUSEHOLD DIETARY DIVERSITY SCORE

Cash Mean HDDS BASE HDDS MID HDDS FINAL 5.51 6.09 6.52 SD 1.92 1.94 1.85 N 166 147 147 Mean 5.12 5.99 6.42 Food SD 1.9 1.6 1.98 N 171 146 147 Mean 5.31 6.04 6.47 Total SD 1.92 1.78 1.91 N 337 293 294

Conclusions The provision of cash or food for eight months when clients start ART confers similar and significantly positive effects in improving clients' nutrition and health.