Nutrition Optimization Using Responsive Implementation Strategies for HIV health (NOURISH) - The University of Massachusetts Lowell (UML), AIDS United (AU), Boston University (BU), and Impact Marketing and Communications (IM), with their interdisciplinary Advisory Council, are pleased to submit a proposal to serve as the Implementation Technical Assistance Provider for Health Resources & Services Administration’s HIV/AIDS Bureau, (HRSA HAB), Nutrition Interventions to Reduce Chronic Disease and Improve HIV Outcomes for People with HIV (HRSA-26-111). Our initiative, Nutrition Optimization Using Responsive Implementation Strategies for HIV health (NOURISH), will identify, adapt, implement, evaluate, and disseminate nutrition service interventions aligned with Ryan White HIV/AIDS Program (RWHAP) service categories, including Medical Nutrition Therapy (MNT), Food Bank/Home Delivered Meals, and other applicable support services. The project will focus on nutrition service models that improve food security and dietary quality, increase uptake of medically appropriate foods, lower stress, reduce metabolic and cardiometabolic chronic disease burden, and support HIV health outcomes among people with HIV. Members of our team and Advisory Council bring decades of experience and expertise in: 1) HIV implementation science, 2) community-engaged HIV and nutrition interventions, 3) nutritional epidemiology, 4) food security, 5) cardiometabolic outcomes, 6) behavior change, 7) aging research, 8) multisite evaluation and data systems, 9) capacity building and technical assistance, 10) financing, 11) sustainability planning, and 12) disseminating results and lessons learned to other RWHAP recipients. Collectively, we have worked together for a decade collaborating with over 90 RWHAP-funded organizations and people with HIV on innovative interventions to improve access to care and adherence to treatment and address psychosocial needs to improve HIV health outcomes for people with HIV. Through NOURISH, we will accomplish four main goals: 1) Identify evidence-based and emerging nutrition service interventions aligned with RWHAP service categories and select and award 10 demonstration sites to implement these interventions in collaboration with HRSA and our Advisory Council; 2) Provide tailored remote and on-site training and technical assistance (T/TA) to implement, evaluate, adapt and sustain sites’ nutrition service interventions and monitor fidelity for modifications, and adaptations and organizational policy changes; 3) Design, plan, and conduct a multi-site implementation science evaluation of the nutrition service interventions across the 10 selected demonstration sites, assessing implementation outcomes, service delivery outcomes, and client-level outcomes related to nutrition security, metabolic and cardiometabolic health, HIV care, and healthcare utilization; 4) Disseminate user-friendly implementation products, evaluation findings, and lessons learned to support replication and sustainment of nutrition security among RWHAP recipients. We will achieve these goals through collaboration with HRSA and the demonstration sites. Using HRSA/HAB’s Implementation Science Framework and Proctor’s Model for Implementation Research, we will conduct a mixed-methods study to examine the fit, barriers facilitators and inner/outer context of the sites’ nutrition service interventions and their implementation, service and client outcomes. The NOURISH team will support sites through fiscal management and monitoring, technical assistance and sustainability planning to integrate their nutrition service interventions in their care settings for long term impact. Our approach is in line with the RWHAP goals for 2030 for people with HIV who are out of care or not virally suppressed through focused nutrition service interventions, leveraging partnerships with food pantries and vendors, and community engagement with people with HIV to live healthier lives.
