Nutrition Education Intervention for PLHIV

improving the overall nutrition-related knowledge and its reflection on patients' dietary knowledge, attitudes, and practices.

The data was collected face-to-face using a questionnaire adapted from the relevant literature including questions related to nutrition knowledge, attitude, and practices (KAP) of HIV patients attending an outpatient clinic in India. This questionnaire assessed all 3 aspects, where the score ranges of knowledge, attitude, and practices are 0-14, 14-42, and 0-13, respectively. The total score of all three subsections ranges between 13-69 where a score between 13 and 32 represents poor KAP values, 33-51 average, and 52-69 good values. The original scores were modified in our study based on face and content validity results.

Improving the food intake of immune-boosting foods and food groups (e.g.: fruits and vegetables, protein-containing food groups).

Two-non-consecutive days 24-hour dietary recalls was used both pre- and post-intervention to measure the intake of total calories and protein as well as nutrients of immune-boosting properties (Vitamin A, Vitamin C, Vitamin E, Vitamin D, Selenium, Zinc, omega 3 omega 6 fatty acids, Iron). Additionally, a qualitative food frequency questionnaire was developed from the literature on the immune-boosting food groups. It was used to measure the change in intake of the immune-boosting food groups pre- and post-intervention period. It covered 10 components (fruits, vegetables, animal-derived protein food sources, plant-based protein food sources, whole grains, nuts, seeds, probiotic-rich foods, herbs, plant-based monounsaturated fatty acids rich oils, plant-based polyunsaturated fatty acids rich oils).

Improving the physical activity levels and anthropometric measurements of PLHIV.

Physical activity level (active versus inactive) was determined using a questionnaire developed by the American College of Sports Medicine for assessing the physical activity level of patients in clinical settings, namely the "Physical Vital Sign Questionnaire". The physically active versus inactive status is determined following the Physical Activity Guidelines for Americans, 2023, which recommend a physical activity level for adults of 150 minutes of moderate-intensity physical activity and 2 days of muscle-strengthening activity.

Any participant performing any kind of physical activity for 150 minutes/week as well as 2-3 days of muscle strengthening workouts is considered physically active. Any participant below 150 minutes/week and no strength training whatsoever is considered physically inactive.

The measurements of weight is kilograms and the height in centimeter will be aggregated to arrive at one reported value which is BMI in Kg/m^2.

Improving the nutrition-related biochemical lab values in relation to adjustment of patients' dietary and lifestyle factors.

Biochemical measurements were collected from the patient's medical files pre- and post-intervention for both control and intervention group.

Reference Range for each biochemical parameter:

Viral load: Ref not detected (Negative) copies/mL. CD4: Ref 219 - 1,621 CELL/uL. Hemoglobin: Ref males 13.0 - 17.0 g/dL versus females 12.0-15.0 g/dL. ALT: Ref males 0-41 U/L versus females 0-31 U/L. AST: Ref males 0-40 U/L versus females 0-32 U/L. Creatinine: Ref: males 0.7-1.2 mg/dL versus females 0.5-0.9 mg/dL. Urea: Ref 12-40 mg/dL. HbA1c: Ref more than5.7% - 5.7-6.4% prediabetes - >=6.5 diabetes. eGFR: Ref more than 60 mL/min/1.73(2) VitaminD3: Ref 30-100 ng/mL. LDL: Ref less than 115 mg/dL HDL: Ref above40 mg/dL men, above 48 mg/dL women. Triglyceride: Ref less than 90 mg/dL

Change of the overall mental health status of PLHIV.

Screening of mental health was done using the questionnaire Hospital Anxiety and Depression Scale (HADS) used to assess the prevalence of anxiety and depression. A score of 0-7 is normal, 8-10 mild anxiety/depression, 11-14 moderate anxiety/depression, 15-21 severe anxiety/depression. A validated Arabic version of the questionnaire was used on Arabic-speaking patients. A HADS score on each sub-section above 11 is elevated and needs further assessment by a psychologist.