Prescription of nutritional interventions to HIV patients in Dar es Salaam, Tanzania

Abstract

Background Anemia and micronutrient deficiencies are common among people living with HIV (PLHIV). There are no current guidelines from the World Health Organization (WHO) regarding whether supplements are recommended or not. We sought to assess the practices with respect to nutritional supplementation among clinicians providing care to people living with HIV in Dar es Salaam, Tanzania. Methods We conducted a cross-sectional survey at clinics providing care to PLHIV in Dar es Salaam, Tanzania. All healthcare workers with prescribing responsibility were invited. Self-administered questionnaires were used to collect information about participants demographic and professional characteristics, and their approach to making decisions regarding the prescription of nutritional interventions. Descriptive analyses regarding prescribing patterns and associated factors were done. Results Two hundred and fifty-four clinicians participated in the survey. They were clinical officers (65%), medical assistants (21%) or medical doctors (13%), and attended to 30 patients (IQR: 10, 100) on average, per week. While the majority usually prescribed iron and multivitamin supplements (79% and 76%, respectively), only 33% usually prescribed ready-to-use therapeutic foods (RUTF). The decision to prescribe nutritional supplements were typically guided by patients clinical condition and laboratory test results. Pallor was the most commonly considered clinical feature across patient subgroups. Most participants commenced supplementation when hemoglobin concentration was ≤10g/dl. Clinicians who attended to between 10 and <100 patients or believed in the need for universal iron supplementation for pregnant PLHIV were more likely to prescribe iron supplements compared to counterparts who attended to <10 patients weekly or who did not believe in the need for universal iron supplementation for pregnant PLHIV respectively. Conclusion Clinicians frequently prescribe nutritional supplements, with considerable variation in how they decide whether and how to.