article · PLOS Global Public Health
Integrating nutritional care into HIV treatment remains a critical challenge in Sub-Saharan Africa. An evaluation conducted in Dar es Salaam, Tanzania, assessed healthcare providers' adherence to national nutritional guidelines for people living with HIV. Across 478 patients receiving care, only 19.5 percent received management that fully complied with these national standards. While anthropometric measurements were taken for all patients, just 1 percent were provided with micronutrient supplements. Higher patient education levels and care delivered at referral hospitals were strongly linked to better guideline adherence. In contrast, nurse attendance, designated adequate staffing levels, and urban residence correlated with poorer compliance. Identified facilitators for guideline implementation included regular staff training and supportive facility leadership, whereas major barriers included financial limitations and high staff turnover. Improving adherence requires addressing resource distribution, healthcare provider training, and patient education.
Proper nutrition is essential for the effective treatment and long-term health of people living with HIV. This research shows that despite having national guidelines, the actual delivery of nutritional interventions such as micronutrient supplementation remains severely limited in clinics. Pinpointing the operational bottlenecks helps health systems direct resources to where they are needed most.
The abstract does not indicate an application pathway, as it focuses on clinical adherence and public health policy rather than commercial technologies or products.
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The dual burden of HIV and malnutrition is a significant public health challenge in high burden Sub-Saharan African countries. Tanzania is no exception. Care and treatment of HIV has been strengthened in these countries, however integration with nutrition care and support remains poor. This study evaluated adherence to nutritional guidelines for people living with HIV (PLHIV) in Dar es Salaam Tanzania and identified its influencing factors. A mixed method study was conducted among PLHIV, health facility administrators, and healthcare providers from April 29 to May 27, 2024. Data were collected through observation checklists, structured questionnaires, and in-depth interviews. Statistical and qualitative analyses were performed to assess adherence and determinants. Among 478 participants who received care, only 19.5% were managed while adhering to the national nutritional guidelines. Universally, anthropometric assessments were taken, however, only 1% received micronutrient supplements. Higher education (AOR = 5.08, p = 0.019) and attendance at referral hospitals (AOR = 8.23, p = 0.032) positively influenced adherence. Conversely, nurse attendance (AOR = 0.34, p = 0.038), adequate staffing (AOR = 0.31, p = 0.010), and urban residence (AOR = 0.47, p = 0.009) negatively influenced adherence. Key facilitators included consistent training and supportive leadership while financial constraints and high staff turnover remained important barriers. There is a significant gap in adherence to nutritional guidelines among PLHIV in Dar es Salaam, Tanzania. This highlights the need for improved resource distribution, staff training, and clients education in Tanzania and countries with similar contexts.
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DOI: 10.1371/journal.pgph.0003664
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