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Project Title: Strengthening Uganda Systems for Treating AIDS Nationally

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Project Title: Strengthening Uganda Systems for Treating AIDS Nationally (SUSTAIN) Study title: Assessment of Dietary Patterns for People Living with HIV seeking health services from Regional Referral Hospitals in Uganda Twaha Rwegyema, BSC. Human Nutrition and Dietetics, MPH HIV/AID Nutrition Program Officer, SUSTAIN Project, University Research Co., LLC – Center for Human Services Plot 7, Ntinda View Crescent, Naguru. P.O. Box 28745, Kampala - Uganda Email: [email protected], Tel: +256-7540601879 Martin K Mbonye, PhD Senior Monitoring and Evaluation Advisor SUSTAIN Project, University Research Co., LLC – Center for Human Services Plot 7, Ntinda View Crescent, Naguru. P.O. Box 28745, Kampala - Uganda Email: [email protected], Tel: +256-752368550 Dr. Alima Hillary, MD, MPH Care & Treatment Advisor, SUSTAIN Project, University Research Co., LLC – Center for Human Services Plot 7, Ntinda View Crescent, Naguru. P.O. Box 28745, Kampala - Uganda Email: [email protected], Tel (Cel): +256-772-412910 Dr. Augustin Muhwezi, MD, MPH Chief of Party, SUSTAIN Project, University Research Co., LLC – Center for Human Services Plot 7, Ntinda View Crescent, Naguru. P.O. Box 28745, Kampala - Uganda Email: [email protected], Tel: +256-774194514 August 2016 Table of Contents List of Acronyms ......................................................................................................................................... iii Abstract ........................................................................................................................................................ iv Operational definitions .................................................................................................................................. v 1.0 Introduction ............................................................................................................................................. 1 1.1 Background ......................................................................................................................................... 1 1.2 Problem statement ............................................................................................................................... 3 1.3 Justification ......................................................................................................................................... 4 2.0 Objectives ............................................................................................................................................... 5 2.1 Main objective .................................................................................................................................... 5 2.2 Specific objectives .............................................................................................................................. 5 3.0 Methods................................................................................................................................................... 6 3.1 Study design ........................................................................................................................................ 6 3.2 Study area............................................................................................................................................ 6 3.3 Study population ................................................................................................................................. 6 3.4 Sampling and sample selection criteria ............................................................................................... 6 3.4.1 Sample size determination ........................................................................................................... 6 3.4.2 Sample size determination formula .............................................................................................. 7 3.4.3 Sample selection ........................................................................................................................... 8 3.5 Inclusion and exclusion criteria .......................................................................................................... 9 3.5.1 Inclusion criteria .......................................................................................................................... 9 3.5.2 Exclusion criteria ......................................................................................................................... 9 3.6 Study variables .................................................................................................................................... 9 3.6.1 Dependent variables .................................................................................................................... 9 3.6.2 Independent variables ................................................................................................................ 10 3.7 Data Management ............................................................................................................................. 10 3.7.1 Data collection procedures ........................................................................................................ 10 3.7.2 Training of Research Assistants ................................................................................................. 11 i 3.7.3 Tools ........................................................................................................................................... 11 3.7.4 Pretesting of the tool .................................................................................................................. 12 3.7.5 Field editing of the data ............................................................................................................. 12 3.7.6 Data entry .................................................................................................................................. 12 3.7.7 Data coding ................................................................................................................................ 12 3.7.8 Quality control ........................................................................................................................... 12 3.8 Data Analysis .................................................................................................................................... 13 3.8.1 Analysis techniques, presentation of data and tests for significance ......................................... 13 3.9 Ethical considerations ....................................................................................................................... 13 3.9.1 Ethical review and approval process ......................................................................................... 13 3.9.2 Informed consent ........................................................................................................................ 14 3.9.3 Confidentiality ............................................................................................................................ 14 3.10 Study Limitations ............................................................................................................................ 14 3.11 Report writing ................................................................................................................................. 14 4.0 Dissemination of report findings ....................................................................................................... 15 5.0 Study Timeline .................................................................................................................................. 15 6.0 References ............................................................................................................................................. 16 ii List of Acronyms AIDS Acquired Immunodeficiency Syndrome ART Antiretroviral Therapy BCC Behavioral Change Communication CDC Center for Disease Control and Prevention HDDS Household Dietary Diversity Score HIV Human Immune Virus IDDS Individual Dietary Diversity Score NACS Nutrition Assessment Counseling and Support PLHIV Persons Living with HIV REE Resting Energy Expenditure SUSTAIN Strengthening Uganda Systems for Treating AIDS Nationally TEE Total Energy Expenditure USAID United States of Agency International Development iii Abstract Introduction: Interactions between food insecurity, malnutrition, and HIV/AIDS are well established. High rates of malnutrition among HIV/AIDS infected children have been widely reported. In addition, several studies consistently show that malnutrition is a strong independent predictor of mortality among people living with HIV (PLHIV). Many factors associated with wasting/malnutrition among PLHIV including metabolic alterations have been reported. Some studies have also reported a significantly positive correlation between food assistance and mean weight gain among PLHIV. The Uganda Ministry of Health has developed nutrition counseling job aides that focus mainly on nutrients and food groups. But these job aides are too generic and include limited and general examples of food types per food group and nutrient type with less emphasis on specific foods commonly available in different geographical areas. Understanding the different common types of foods available in different regions is key to understanding the dietary patterns for PLHIV. This is key to promoting nutrition counseling guided by food types easily accessed by the PLHIV and could improve
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