Improving Antiretroviral Therapy Adherence Through Urban Gardening and Nutritional Counseling in the Dominican Republic
Improving Antiretroviral Therapy Adherence Through Urban Gardening and Nutritional Counseling in the Dominican Republic
This pilot study proposes to develop, implement, and evaluate the feasibility, acceptability
 and preliminary effectiveness of a culturally appropriate, multi-component intervention
 combining peer nutrition counseling with sustainable urban gardening among people with HIV in
 the Dominican Republic. The overall hypothesis is that this combined intervention will
 improve adherence to antiretroviral therapy (ART) and virologic suppression among food
 insecure HIV+ individuals with suboptimal adherence.
The purpose of this pilot clinical trial is to evaluate the feasibility, acceptability, and
 preliminary effectiveness of a culturally appropriate, multi-component intervention that
 targets food insecurity and nutritional health with the ultimate goal of improving
 antiretroviral therapy adherence and virologic suppression for people with HIV in the
 Dominican Republic. Through an initial phase, we conducted formative research on dietary
 patterns and locally available foods and, together with our preliminary research on
 nutritional counseling and urban gardening, developed a multi-component nutrition
 intervention to address food insecurity among people with HIV that integrates
 culturally-appropriate, peer-led nutritional education with a sustainable urban garden
 component. During the clinical trial phase, we will enroll 120 HIV+ adults with food
 insecurity and suboptimal adherence in 2 HIV clinics (60 participants in the intervention
 clinic and 60 participants in the control clinic) and will evaluate the feasibility,
 acceptability and preliminary effectiveness of urban gardening plus peer nutritional
 counseling on improving virologic suppression and ART adherence in both the short (month 6)
 and longer terms (month 12). We will also explore preliminary intervention effects on
 potential mediators (food security, nutritional status, internalized HIV stigma, and social
 support). As one of the first studies to develop a sustainable food production approach with
 peer nutrition counseling among people with HIV, key products will include: 1) an easy-to-use
 peer nutritional counseling curriculum and urban gardens training materials; 2) pilot data on
 the feasibility, acceptability, and effects of our intervention on primary outcomes and
 potential mediators; and 3) if results are promising, an R01 application to conduct a
 fully-powered cluster randomized controlled trial that examines effects across a larger
 number of clinics in the Dominican Republic.
Inclusion Criteria:

 -  HIV+ and on ART

 -  Has moderate or severe household food insecurity

 -  Has detectable viral load (>50 copies) and/or suboptimal adherence to ART

 Exclusion Criteria:

 -  Does not meet above criteria