An evaluation of nutrition care to adult patients on Highly Active Antiretroviral Therapy (HAART) attending primary healthcare facilities in Mbombela North, Mpumalanga

[摘要] ENGLISH SUMMARY : Background: South Africa has the most people infected with the human immunodeficiency virus (HIV) in the world; however the rollout of highly active antiretroviral therapy (HAART) is expanding. Treatment of HIV is changing and improving, altering the nutritional status of patients in this era. Mpumalanga has the second highest HIV burden, with most patients accessing care from primary healthcare (PHC) facilities. However, information regarding the current nutrition care received by adult patients on HAART attending these facilities is lacking.Aim: To evaluate the nutrition care received by adult patients on HAART attending PHC facilities in Mbombela sub-district, in Ehlanzeni district, Mpumalanga.Methods: A cross-sectional descriptive study design was used. Subjects included 263 adult patients on HAART and 75 nursing professionals. An assessment of 19 PHC facilities was also conducted. An interviewer-administered questionnaire was completed for each patient, along with pre-defined anthropometric measurements. Nursing professionals completed a self-administered questionnaire. An assessment tool was completed for each PHC facility.Results: A combined total of 41.4% of patients were overweight or obese, and most (51.8%) females had a body mass index (BMI) ≥ 25. Based on waist circumference, 52.7% of females and 8.4% of males were at increased risk of cardiovascular disease. Although nurses were aware of a nutrition supplementation programme (NSP), knowledge of the national nutrition supplementation programme guideline (NNSPG) details was inadequate and the programme was poorly implemented. Only three nurses correctly identified entry criteria into the NSP. Clinical judgement, rather than eligibility criteria, was used to identify patients eligible for supplementation, with 13.3% of patients receiving nutrition supplementation at the time of the study, when only 4.9% qualified for supplementation according to the guidelines. Nurses were confident about their knowledge of nutrition-related topics, but this did not match actual knowledge. Nutrition counselling was frequently (66.2%) guided by general knowledge and patients expressed a need for more nutrition information. Most patients (70.7%) had a previous weight recorded on file, while only 6.1% had height and 4.6% had BMI records available. PHC facilities generally had sufficient equipment available, storage conditions were fair, but stock shortages of nutrition supplements posed a major problem. Most patients (76.0%) and nurses (69.3%) rated the nutrition care received/provided as 'Good' or 'Excellent'.Conclusion: Certain aspects of nutrition care to adults on HAART are good. However, care could be improved through training and support to professional nurses, focusing particularly on BMI and nutrition counselling to encourage the consumption of appropriate portions of balanced meals and promote household food security. Counselling should be guided by recognised guidelines and focus on preventing over-nutrition and associated disease. Nurses should be familiarised with the NNSPG through formal training and have a constant nutrition supplement supply, in order to implement them correctly. It may be worthwhile to consider modifying the supplementation programme to better meet the needs of the majority of patients who are not undernourished, but who are food insecure. However, better monitoring and evaluation of nutrition care to adult patients receiving HAART from PHC facilities are needed.

[发布机构] Stellenbosch University