Project GLOW: Glucose Levels for Optimizing Wellness for People Living with HIV - People living with HIV/AIDS (PLWH) are at increased risk for type 2 diabetes due to age-related metabolic changes and risk factors such as poor dietary quality, HIV infection and ART use. Diabetes is commonly reported among PLWH as people live longer, with estimates varying from 12-30%. Novel cost-effective non pharmaceutical approaches to prevent diabetes for aging PLWH are needed but require multilevel interventions that address the structural factors affecting dietary change and medical adherence. Food insecurity is 2-3 times higher in PLWH than the general population. Food insecurity is associated with poorer dietary quality due to consumption of cheaper, less nutritious foods, stress, and poor health outcomes, such as diabetes, lower ART adherence, lower CD4+ counts, and unsuppressed viral load. Few dietary interventions, however, have targeted prevention or management of diabetes in PLWH, and those that have, are small, provide pre-packaged meals, and/or lack a control group. While pre-made meals designed for specific diseases can improve health outcomes, they do not address nutrition knowledge and cooking efficacy, which are important for developing long term dietary behavior change. Studies using meal kits (high quality ingredients and simple recipes) have been shown to improve dietary quality, food insecurity, and psychosocial health, but studies have been limited by a lack of nutrition education needed for long-term use of meal kits. Dietary recommendations for prevention of diabetes in PLWH, who are food insecure, have been hindered by a glaring gap in a lack of well-designed interventions and rigorously collected data. To address this gap, Project GLOW (Glucose Levels for Optimizing Wellness for People Living with HIV) aims to improve diet, glycemic and HIV outcomes for aging PLWH with prediabetes through implementation of a food security intervention at a clinic in the Boston/Suffolk County EMA, a priority jurisdiction for ending the HIV Epidemic. Guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework, we will engage patients and health care providers to identify barriers and facilitators to study processes and change in health outcomes to implement and refine the intervention. Our hypothesis is that tailored education with complementary food provision will reduce food insecurity and improve dietary behaviors and glycemic and HIV outcomes. This pilot and feasibility trial will randomize 100 PLWH aged >40 years to intervention (n=50) or usual care (n=50) with measures at baseline and 16-weeks and post 12 months for sustainment. This study contributes to NIDDK’s scientific goal of advancing research to disseminate and implement evidence based prevention strategies and treatments in clinics and community settings, to improve the health of all people, more rapidly and more effectively.
