Infectious Disease · Medical Literature
Impact of Nutrition Education on Nutrition Knowledge, Attitudes, Practices, and Immune-Related Nutrient Intake in People Living with HIV: A Randomized Controlled Trial.
Abstract
Objective: Nutrition is critical for people living with human immunodeficiency virus (PLHIV); nonetheless, nutritional interventions have not been conducted among PLHIV in the Middle East and North Africa region. This study evaluated the effects of a nutrition-related education intervention on total knowledge, attitude, and practice (KAP) scores and on the intake of immune-enhancing foods and nutrients among PLHIV. Methods: Sixty-three PLHIV were recruited from an outpatient HIV clinic in Dubai, United Arab Emirates, between August and November 2023 and randomly assigned to an intervention (n = 31) or control group (n = 32). The intervention group participated in an individualized, six-session nutrition education program based on the Health Belief Model, whereas the control group received usual care plus a nutrition education brochure on HIV nutrition and health. Data were collected at baseline and after the five-month intervention period using validated instruments assessing HIV-related nutrition knowledge, attitudes, and practices. A food frequency questionnaire and two non-consecutive 24 h dietary recalls were used to assess the intake of immune-enhancing nutrients. Results: Post-intervention KAP score distributions differed significantly between the control and intervention groups for knowledge, attitude, and practices (p < 0.001, 0.003, and 0.001, respectively). Immune-enhancing vitamin intake did not differ significantly between groups, except vitamin E, which increased in the intervention group (p = 0.042). Conclusions: The intervention improved participants' nutrition-related KAP scores but did not increase the intake of immune-enhancing nutrients, except for vitamin E. Further studies are warranted to develop interventions that improve the intake of immune-enhancing nutrients.
Clinical relevance
Does a structured, individualized six-session nutrition education program based on the Health Belief Model improve nutrition knowledge, attitudes, practices (KAP), and the intake of immune-enhancing nutrients in people living with HIV (PLHIV) attending an outpatient clinic in Dubai, UAE, compared with usual care plus a standard nutrition brochure? __SNAPSHOT__ {"studyDesign":"Randomized controlled trial (parallel-arm, two-group, stratified randomization)","setting":"Single outpatient HIV clinic, Dubai, United Arab Emirates","sampleSize":"n = 63 (intervention: n = 31; control: n = 32)","population":"Adults aged 18–60 years living with HIV, residing in Dubai; excluded individuals with psychiatric illness or who were incarcerated; gender-stratified sampling reflecting clinic demographics (~80% male, ~20% female); recruited August–November 2023","intervention":"Individualized six-session nutrition education program (~5 months duration) grounded in the Health Belief Model, plus standard nutrition brochure","comparator":"Usual care plus a nutrition education brochure on HIV nutrition and health","primaryOutcome":"Post-intervention total knowledge, attitude, and practice (KAP) scores, assessed with validated HIV-related nutrition instruments; anticipated between-group increases of ≥1.71 (knowledge), ≥1.08 (attitude), and ≥1.20 (practice) points","followUp":"Approximately 5 months (baseline and post-intervention assessments)","fundingSource":"Not reported"}
Key findings
Post-intervention KAP score distributions differed significantly between the intervention and control groups for all three primary domains: knowledge (p < 0.001), attitude (p = 0.003), and practice (p = 0.001). No absolute mean differences, confidence intervals, or effect sizes for KAP scores are reported in the available abstract. Regarding secondary outcomes, immune-enhancing vitamin intake did not differ significantly between groups for the majority of nutrients assessed; the only exception was vitamin E, for which intake increased in the intervention group relative to control (p = 0.042). No NNT/NNH can be calculated from the available data. Adverse events were not reported in the abstract. All statistical values are as reported in the source abstract; no values have been independently calculated.
Practice implications
This trial established that a structured, Health Belief Model–based nutrition education intervention significantly improved nutrition-related knowledge, attitudes, and self-reported practices in PLHIV attending a single outpatient clinic in Dubai over approximately five months. However, the intervention did not translate into meaningful improvements in dietary intake of immune-enhancing nutrients, with the sole exception of vitamin E — a finding that raises the critical question of whether KAP gains are sufficient surrogates for actual nutritional and, ultimately, clinical immunological outcomes in this population. The finding that behavior change (eating patterns) lagged behind knowledge and attitude change is consistent with broader behavioral nutrition literature and represents a clinically important gap. The study enrolled a geographically and demographically narrow population (Dubai residents, predominantly male, single-site), limiting generalizability to PLHIV in other Middle Eastern, North African, or Western settings. HIV disease stage, ART regimen, CD4 count, viral load, and baseline nutritional status are not characterized in the available abstract, preventing determination of which HIV disease strata the results apply to. Given that only an abstract was accessible for this summary, quantitative precision regarding effect sizes, confidence intervals, and subgroup performance cannot be fully evaluated — a critical limitation for evidence-based clinical application. Practice change is not warranted on the basis of this single small trial alone. __LIMITATIONS__ Very small sample size (n = 63 total), likely underpowered to detect modest but clinically meaningful differences in dietary nutrient intake across multiple micronutrients; the pre-specified sample size (n = 27/group) was based on KAP differences, not dietary intake outcomes.,Single-site, single-city study (Dubai, UAE) with a highly specific demographic (predominantly male Dubai residents); severely limits generalizability to broader PLHIV populations.,Lack of blinding is inherent to educational interventions, introducing performance and detection bias; participants and educators could not be masked.,Self-reported dietary assessment (24-hour recalls and food frequency questionnaire) is susceptible to recall bias and social desirability bias, particularly among participants aware of receiving a nutritional intervention.,Primary outcomes (KAP scores) are surrogate endpoints; the study did not assess clinical outcomes such as CD4 count, viral load, weight, or immune function.,The disconnect between improved KAP and largely unchanged dietary intake suggests that knowledge gains alone are insufficient to drive behavior change; this limits the clinical relevance of the primary endpoint.,Follow-up was limited to approximately 5 months; durability of KAP improvements and any dietary changes beyond this period are unknown.,Funding source is not reported, limiting assessment of potential sponsorship bias.,Statistical significance was achieved for KAP outcomes, but absolute effect sizes, confidence intervals, and clinical importance of the KAP score changes are not available in the abstract.,No characterization of HIV disease severity, ART type, baseline CD4 count, or viral load in the abstract, limiting assessment of which HIV clinical strata were studied.,Only abstract available for this review; full data tables, adjusted analyses, and attrition details could not be evaluated. __BOTTOM_LINE_CATEGORY__ promising_but_preliminary __BOTTOM_LINE__ A five-month individualized nutrition education program based on the Health Belief Model significantly improved HIV-related nutrition knowledge, attitudes, and practices in a small cohort of PLHIV in Dubai, but did not meaningfully improve intake of immune-enhancing nutrients (with the sole exception of vitamin E). These findings suggest that educational interventions alone are insufficient to achieve dietary behavior change in this population and that additional structural or behavioral support strategies are likely required. Larger, multi-site trials with clinical and immunological endpoints are necessary before this type of intervention can be considered for routine practice adoption.