The effect of community-based nutritional interventions on children of women living with HIV in rural India: A 2 x 2 factorial intervention trial

BACKGROUND: Malnutrition is a common clinical concern among children in low-income communities affected by HIV. We examined the effect of a community-based nutritional intervention on anthropometric and clinical outcomes of children of women living with HIV in rural India. METHODS: We assigned women living with HIV and their child (oldest 3-8 years) to one of the four programs: 1) community-based HIV care program; 2) Program 1 + nutritional education; 3) Program 1 + food supplement; and 4) all elements of Programs 1-3. Study data were collected at baseline, months 6, 12, and 18. We applied mixed-effects modeling with restricted maximum likelihood estimation to examine changes in weight (all children) and CD4+ T cell counts (HIV-infected children only). RESULTS: Overall, 600 mother-child pairs were enrolled (150 per group) with 100% retention at follow-up visits. Approximately 20% of children were living with HIV. Children in Program 4 had higher weight gain compared to Programs 1, 2 and 3 at all time points (adjusted p < 0.001). We found higher increase in CD4+ T cells across all time points among participants in Programs 3 and 4 compared to Program 1 (adjusted p < 0.001). Factorial analysis suggested a synergistic effect of combining nutritional education and food supplements for weight gain, but not for increase in CD4+ T cells. CONCLUSIONS: A combination of nutrition education and food supplements provided to women living with HIV significantly increased weight and CD4+ T cells and such interventions can be integrated into HIV care programs in low-income settings.