RESUMO
OBJECTIVE: To assess the impact of nurse-led Asha (Accredited Social Health Activist)-support behavioral and nutritional intervention among women living with HIV/AIDS (WLH/A) in rural India. DESIGN: Cluster randomized controlled trial. METHODS: Sixteen Primary Health Centers serving WLH/A in Andhra Pradesh were grouped into four regional clusters that were randomly allocated into one of four arms. All four groups included Asha-support and consisted of: Asha-support only (control group); nutrition education; nutrition supplementation; and the combination of supplementation and education. Differences between baseline and 6-month follow-up for key physiological outcomes (BMI, CD4 cell count) were analyzed using factorial mixed models that accounted for geographic clustering. RESULTS: At 6 months, all groups improved CD4 cell count: Asha only [mean difference score (D)â=â343.97, standard deviation (SD)â=â106.94], nutrition education (Dâ=â356.15, SDâ=â0.69), nutrition supplement (Dâ=â469.66, SDâ=â116.0), and nutrition supplement and education (Dâ=â530.82, SDâ=â128.56). In multivariable models, Asha-support and nutrition, and Asha-support and nutrition supplement interventions demonstrated independent significant improvements in CD4 cell count; the interaction term was significant [estimateâ=â529.9; 95% confidence interval (CI) 512.0, 547.8; Pâ=â0.006]. BMI also increased for all groups: Asha only (Dâ=â0.95, SDâ=â0.82), Asha and nutrition education (Dâ=â1.28, SDâ=â0.53), Asha and nutrition supplement (Dâ=â2.38, SDâ=â0.60), nutrition supplement, and nutrition supplement and education (Dâ=â2.72, SDâ=â0.84). Nutrition supplementation and nutrition education demonstrated independent effects on BMI; the interaction term was not significant (estimateâ=â0.27; 95% CIâ=â2.5, 2.7; Pâ=â0.80). CONCLUSION: Interventions supported by community workers were efficacious at improving physiological outcomes and may be beneficial at meeting critical healthcare needs of vulnerable WLH/A in India.
