Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries

Objective: To examine the availability of nutritional support services in HIV care and treatment sites across sub-Saharan Africa. Design: In 2008, we conducted a cross-sectional survey of sites providing anti-retroviral therapy (ART) in nine sub-Saharan African countries. Outcomes included availability of: (i) nutritional counselling; (ii) micronutrient supplementation; (iii) treatment for severe malnutrition; and (iv) food rations. Associations with health system indicators were explored using bivariate and multivariate methods. Setting: President's Emergency Plan for AIDS Relief-supported HIV treatment and care sites across nine sub-Saharan African countries. Subjects: A total of 336 HIV care and treatment sites, serving 467 175 enrolled patients. Results: Of the sites under study, 303 (90%) offered some form of nutritional support service. Nutritional counselling, micronutrient supplementation, treatment for severe acute malnutrition and food rations were available at 98%, 64%, 36% and 31% of sites, respectively. In multivariate analysis, secondary or tertiary care sites were more likely to offer nutritional counselling (adjusted OR (AOR): 2.2, 95% CI 1.1, 4.5). Rural sites (AOR: 2.3, 95% CI 1.4, 3.8) had increased odds of micronutrient supplementation availability. Sites providing ART for >2 years had higher odds of availability of treatment for severe malnutrition (AOR: 2.4, 95% CI 1.4,4.1). Sites providing ART for >2 years (AOR: 1.6, 95% CI 1.3, 1.9) and rural sites (AOR: 2.4, 95% CI 1.4, 4.4) had greater odds of food ration availability. Conclusions: Availability of nutritional support services was high in this large sample of HIV care and treatment sites in sub-Saharan Africa. Further efforts are needed to determine the uptake, quality and effectiveness of these services and their impact on patient and programme outcomes.