Predictors of nutritional recovery among undernourished adults on antiretroviral therapy treated with ready-to-use therapeutic food at public health facilities in Southeast Ethiopia: a retrospective cohort study

Abstract

Undernutrition remains a significant public health challenge among people living with HIV in Ethiopia. To address this issue, the country has implemented programs providing ready-to-use therapeutic foods (RUTF) to improve the nutritional status of this vulnerable population. However, empirical evidence on recovery rates and associated factors for individuals undergoing antiretroviral therapy (ART) remains limited. We investigated the nutritional recovery rate and its predictors among undernourished adult individuals receiving ART and RUTF at public health facilities in the Borena Zone, southeastern Ethiopia, in 2023. A multicenter, institution-based retrospective cohort study was conducted among all 483 undernourished adults treated with RUTF at health facilities in the Borena Zone from January 2017 to December 2022. The study population comprised all undernourished adults living with HIV who received treatment with a ready-to-use therapeutic food. Socio-demographic, clinical, and nutrition-related data were extracted from medical records using an open data kit platform. Bivariable and multivariable Cox regression models were employed to identify predictors of nutritional recovery at 5% significance level. The study found the overall recovery rate was 55.5% [95% CI: 51–60%], with an incidence rate of 14.2 per 100 person-months of observations. The median recovery time was 4 months (95% CI: 3.56, 5.03 months). Attending formal education (AHR: 1.51 [95%CI: 1.13,2.00]), presence of opportunistic infections (AHR: 0.58 [95%CI: 0.43,0.77]), WHO clinical stage I and II (AHR: 1.76 [95%CI: 1.28, 2.41]), severe acute malnutrition (AHR: 0.27 [95% CI:0.19,0.39]) and newly enrolled to ART (AHR:0.59 [95%CI: 0.39, 0.89]) were independent predictors of nutritional recovery. The study demonstrated that the nutritional recovery rate was 55.5%, which fell short of the 75% target. To enhance recovery outcomes, caregivers should prioritize individuals with severe malnutrition and highly compromised immune systems. Implementing routine screening for malnutrition and providing timely treatment for opportunistic infections are crucial strategies to improve recovery among these vulnerable groups. Not applicable.