The Ryan White HIV/AIDS Program (RWHAP) provides HIV-related medical and support services for uninsured and underinsured people living with HIV (PLWH) in the United States. In addition to HIV-related medical care, the program provides medical nutrition therapy and food assistance. The role of nutrition in the health of PLWH is well-documented, especially in resource poor areas; however, the role of medical nutrition therapy and food assistance provided through the RWHAP in resource rich areas is not well documented. This study addressed the association between the nutrition services of food assistance and medical nutrition therapy and the HIV-related health outcomes of viral suppression, retention in care, and CD4 counts. The behavioral model for vulnerable populations was used as the theoretical foundation for this quantitative cross-sectional study. A sample of 428 RWHAP clients was used from the Ryan White Services Report data. Pearson's chi-square was used to examine the association between medical nutrition therapy (MNT) and viral suppression. Findings indicated statistically significant associations between MNT and viral suppression, retention in care and any nutrition service (food assistance, MNT, or both), and MNT and retention in care. Implications for social change include emphasizing the role of nutrition services in HIV-related health outcomes for PLWH in resource rich areas.

The purpose of this study was to evaluate the antiretroviral therapy program in primary health care settings in Lesotho. Mixed methods research using a convergent parallel mixed methods design was used to collect both quantitative and qualitative data which were analysed during the same phase of the research process. Two groups of participants participated in the study, the registered nurse group was composed of registered nurses/midwives/nurse clinicians involved in ART service provision and the second group was composed of adults aged 18 years and older who were HIV/AIDS positive. Quantitative data had a compliance rate of 92% and it were analysed using SPSS (23). Qualitative data were analysed using constant comparison analysis and seven themes, fourteen categories and twenty two sub-categories emerged from the data analysis. Findings of the study revealed that the majority of PHC facilities were staffed by registered nurse midwives and nurse clinicians who were qualified, confident, knowledgeable and competent in the execution of duties. Generally there were a large number of patients that sought ART services which were offered on a weekly basis although there was variation in the actual number of days the services were provided. The time patients spent seeking ART services varied across the facilities and ARVs and other drugs were usually available. Challenges in the delivery of ART services included unsatisfactory staffing resulting in the provision of inadequate services and work overload, lack of knowledge of some patients, use of incentives by some partners and too many partners being involved in ART, inadequate documentary evidence and stigma pertaining to the HIV status of individuals. Furthermore, ARVs were reported to make patients feel hungry hence resulting in lack of satisfaction in ART services, ART services were inadequate due to dysfunctional equipment and some patients had been lost due to inability to screen for cancer and there was incomplete monitoring and evaluation of the ART program. However, participants in this study generally showed their acknowledgement of the ART services as they generally improved their health status despite the many challenges that were being faced. / Health Studies / D.Litt.et Phil. (Health Studies)