Two thirds of persons living with HIV/AIDS reside in Sub-Saharan Africa, where food insecurity and malnutrition are also major public health issues. HIV exposed infants are at particularly high risk for malnutrition because HIV infected mothers may not be able to access or prepare sufficient nutritional foods for optimal infant growth. Food supplementation programs have often been incorporated into HIV programs to improve family food security and nutrition. We propose to do a secondary analyses of data from a perinatal HIV prevention trial at a research center in Kampala Uganda in order to assess the potential effect of introduction of a food supplement program (the World Food Programme, WFP) on the growth of infants enrolled the HIV clinical trial. Growth data from infants enrolled in the trial before the WFP was introduced at the site will be compared to growth data of infants enrolled after introduction of the program. We will also describe infant feeding practices among HIV infected women in the study all of whom received current WHO/Ministry of Health counseling on infant feeding;and assess the relation of duration of breast feeding to infant growth outcomes. The trial dataset for secondary analyses uses data gathered according to rigorous GCP standards and includes sociodemographic, clinical and lab variables, as well as infant feeding practices at each study visit. These data will allow adjustment for other factors which may contribute to good or poor growth outcomes of infants. This application provides a unique and timely opportunity to assess the potential impact of food supplementation program and current WHO breastfeeding recommendations on the growth of HIV-exposed children enrolled in a perinatal HIV trial. The analyses will also permit us to evaluate factors associated with poor infant growth in a resource limited setting. Findings from this study will help inform the WFP nutrition program on their efforts in supporting HIV affected families in Uganda and likewise refine and improve the infant feeding counseling messages given to HIV infected mothers.
The relevance of this proposed research to public health is that severe malnutrition and HIV/AIDS are both major causes of childhood morbidity and mortality in developing countries. Each year, 55% of childhood deaths in developing countries are directly or indirectly attributed to malnutrition. In Uganda, about 70,000-80,000 children are estimated to be living with HIV/AIDS and are at high risk for malnutrition based both on their sociodemographic circumstances and their HIV disease. Information obtained from assessment of the impact of an ongoing food supplementation programme on growth outcomes of HIV infected children as well as HIV exposed but uninfected infants will be extremely useful in strengthening the current nutrition guidelines and practices recommended in the comprehensive care package for these children.
