tb conference - paris - 0810

8/8/2019 Tb Conference - Paris - 0810

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39th Union World Conference on Lun Health

18th October 2008 - Paris

r e h a b i l i t a t i on f o r HI V/ TB p at i en t s: r e h a b i l i t a t i on f o r HI V/ TB p at i en t s: t he use o f t he use o f READ Y TO USE THERAPEUTI C FOODSREAD Y TO USE THERAPEUTI C FOODS

By Filippo Dibari *, ** - PH Nutritionist (MSc), Food Technologist (MSc)

Supervision: Andrew Seal* & Paluku Bahwere** *** ***Support in method design: Saul Guerrero**

*Centre of International Health and Development, Institute of Child Health, UCL, University of London** Valid International United Kin dom

*** MSF-F/Homa Bay, Kenya

Funding provided by Valid International


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1) To describe the acceptability, compliance andadherence to the nutritional rehabilitation

2) To determine key barriers to compliance withthe nutritional rehabilitation

.among malnourished adults living with HIV,,in an MoH/MSF programme in Homa Bay, Kenya

3) To describe the ready to use therapeutic foods(RUTF) for such rehabilitation


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Background

Research design

Participants Results/conclusions

Recommendations

Next ste s


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Back roundBack round


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WHO / WFP / UN-SCN / UNICEF 2007

Ready to Use Therapeutic Food (RUTF)

WHO 1999

u r ona re a a on n severeu r ona re a a on n severePRIMARYPRIMARY malnutritionmalnutrition


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Background:

In HIV+ adults

Plumpynut

increases weight gain

Weight gain >5%

increases survival

(n=450*; BMI


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Back round:Back round:

locationlocation

Homa Bay MoH/MSF-F Hospital

3 HIV/TB decentralized clinics


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Number ofadults (>15 years) in the MoH/MSFHIV/TB programme

In August 2008 :

11,624 patients are HIV and/or TB infected

, are n ec eTB+ and HIV+ and BMI


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Background:Background:

e pro ece pro ec

MoH/MSF HIV OutPatient Programme,

present):

Afya and/or Plumpynut

Average : 118 Standard Deviation: 98

(MSF data; n=22)

Important? Cost in MSF/Homa Bay: 30,000USD/year (estimation)


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R r h D i n: li ivR r h D i n: li iv

Key Informant

Focus group

discussions (FG)

n erv ews

Key informantFocus Groups Direct

Observations

interviews (KI)

Direct unobtrusive

observations (DO)*

* 2 weeks


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The ParticipantsThe Participants


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ParticipantsParticipants

56 participants 28 HIV+

co- n ecte 2 carers

Characteristics All were adults (>15 years)

Of the patients, 29% were recovered and 72% undertreatment

treatment were receiving

Plumpynut only


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The resultsThe results


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ComplianceCompliance

8 22 KI declared to be non com liant with 4 sachets da

Compliance:

2/6 DO died because in severe conditions (no compliance at all)

Positive factors associated to Compliance:

bring strength; soon back to work; weight gain; lesshungry; increasing happiness; etc.

Smell & packaging

Possibility to mix Plumpynut with other foods

Negative factors for Compliance:

Nausea and/or vomit

Taste: too sweet; too oily; too salty; diet boredom

KI = key informants FG = focus groups DO = direct observations


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R lR l P r 1: A iliP r 1: A iliComplianceCompliance

aring practices:

Household food insecurity Sharing with HIV+, not malnourished, partner

Mixing with other foods (once you start mixing,hard to go back):

(1) porridge, (2) bread, (3) vegetables, (4) tea, (5)

chapatti

Reasons for mixing: Boredom; nausea/vomit


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ComplianceCompliance

Counselling: Health staff: uncertain about effectiveness but also I do

not know what to counsel about severe cases

General nut info (protein from meat, eggs, etc.) - useful?

Plumpynut: how to consume it? How often a day?

KI = key informants FG = focus groups DO = direct observations


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R lR l P r 2: K rri rP r 2: K rri r

Su l -related roblems:

Only half of the patients under treatment comewith a carer

is 6 kg (approx. gross weight for 2 weeks)This compares to the approx. 12 kg

required for 4 week gap in between

ART appointment

Stigma : Plumpynut > ART


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ResultsResults Part 2: Key barriersPart 2: Key barriers

Carer very important


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(1)(3)

ResultsResults Part 2: Key barriersPart 2: Key barriers

Buddy very important (5)


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are also prescribed:

Fortified porridge (mixed)

micronutrient intake?

Admission criteria:

Hei ht not reliable with ross weakness BMInot used for entry criteria


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RecommendationsRecommendations


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1. Criteria for micronutrient prescriptions

2. Guidelines for Plumpynut use:

b) Inform patients about side-effects

d) Encourage presence of the carer


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RecommendationsRecommendations2. Guidelines for Plumpynut:

a. Visual estimate of oral sores + treatment

b. If oesophageal candidiasis

[ swallowing test ]

Thrush resent but bearable impossible to swallow

Specific dietetic guidelines

Out-Patient Programme In-Patient Programme(NG; F-75 / F-100)


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3. Collection of second two weeks supply: Carer comes to collect the second two weeks

Community Based Organization involvement

4. Education sessions

5. Anon mous containers

6. Admission criteria Height issue arm span & demi-span* (in-patients) or

MUAC (out-patient)

* Ethnicity specific - De Lucia et al. (2002)


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What is next?

Slide 1/3Ran omize ontro e Tria

The subjects (n=610) of this study are:4.5 USD/Kg ~2.0 USD/Kg

age > yrs

malnourished : BMI


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Pictures : MSF project in Homa Bay, Kenya

thanks for your attention!

For more information on

(or collaborations on new

research to ics :

www.validinternational.or

[email protected]

tb conference - paris - 0810

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