Impact of a novel multicomponent nutrition intervention on cardiovascular disease risk factors among food-insecure adults with HIV in the Dominican Republic
Cardiovascular disease (CVD) is the leading cause of mortality in Latin America and the Caribbean (LAC), and has arisen as a major clinical and public health challenge in HIV. Social and economic vulnerability may potentiate increased CVD risk among PLHIV by reducing access to a healthy diet, increasing stress, and increasing maladaptive coping behaviors (e.g. alcohol consumption and smoking). In particular, research suggests food insecurity as a key structural barrier that may undermine CVD prevention efforts among PLHIV. Interventions to reduce modifiable CVD risk factors among food-insecure PLHIV are critically needed in LAC, where food insecurity and obesity coexist and are highly prevalent. To address this research gap, we propose to evaluate the impact of a novel, multicomponent nutrition intervention on CVD risk factors among food-insecure PLHIV in the Dominican Republic (DR). By leveraging an upcoming parent intervention study (Proyecto para Mejorar la Seguridad Alimentaria, or ProMeSA) conducted by the UN World Food Program and RAND, our proposed study will assess the impact of integrating peer nutritional counseling and urban gardens on CVD risk factors among 120 food-insecure PLHIV receiving ART in the DR (60 intervention, 60 control). Our aims are to assess baseline CVD risk in a sample food-insecure PLHIV on ART in the DR (Aim 1), evaluate the impact of the intervention on improving objective measures of CVD risk [blood pressure, hemoglobin a1c, and cholesterol] (Aim 2), and assess the impact of the intervention on intermediate CVD risk factors suggested by our conceptual framework, including diet quality, obesity, alcohol use, and stress. The results of this research will provide some of the first data on community-based approaches to reduce CVD risk among food-insecure PLHIV in LAC, with the ultimate goal to inform policies and programs to improve health equity in long-term outcomes among PLHIV.