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Dr. Mogomotsi Matshaba, a clinician and researcher at the Botswana-Baylor Children’s Clinical Center of Excellence in Gaborone, Botswana.

Seattle Children’s Research Institute’s mission to prevent, treat and eliminate childhood disease extends far beyond the Pacific Northwest or even the United States. Researchers like Dr. Jason Mendoza, of the institute’s Center for Child Health, Behavior and Development, are advocating for vulnerable patients all over the world. Mendoza recently led a global health research study in Botswana, published in the Journal of Acquired Immune Deficiency Syndromes, to find out if inadequate access to food, also called food insecurity,  might be associated with worse health outcomes of HIV-positive children in Sub-Saharan Africa.

Studying patients with the greatest need

HIV is a major public health problem in Sub-Saharan Africa. In 2012, there were 3.3 million children worldwide, under the age of 15, living with HIV. Of those, 2.9 million were in Sub-Saharan Africa. Botswana has one of the highest HIV rates of countries in this region, with 23% of adults (ages 15 to 49) infected. Additionally, from 2010 to 2012, 27.9% of people in Botswana did not have physical or economic access to enough nutritious food to maintain a healthy, productive lifestyle.

“Knowing how great the burden of HIV is in this part of the world, we wanted to see what we might learn to help children and families there,” Mendoza said.

Scientists know poor nutrition affects the immune system and may cause infections like HIV to progress more quickly. In turn, as a patient’s health worsens, families are often forced to redirect income, assets and time from employment and food procurement to focus on caregiving. Patients who are not consuming adequate nutrition are also less likely to adhere to medication regimens or may not absorb medications as well.

“Young children are especially vulnerable to the effects of food insecurity because of their dependence on caregivers for food and their unique nutritional needs,” Mendoza said. “Even when nutritional aid is provided to a family, it may be divided among many people. Children under 5 are least likely to get the food they need.”

Mendoza previously worked with a team of researchers at Texas Children’s Hospital in Houston to study HIV-positive youth and young adults in the United States and reported an association between poor access to food and lower CD4 counts – the body’s immune cell that HIV attacks. Still, such an association had not been proven in Sub-Saharan Africa, where many more children are affected by HIV.

“HIV affects all aspects of life here,” said study co-author Dr. Mogomotsi Matshaba, a clinician and researcher at the Botswana-Baylor Children’s Clinical Center of Excellence in Gaborone, Botswana. “When infected children are not healthy, they miss school and we see delays in their cognitive and social development. They often fail out of high school, cannot get good jobs and suffer economically. As adults, they are more likely to engage in risky sexual behaviors, perpetuating the cycle of infection.”

A discovery that could influence aid

With funding from the National Cancer Institute, Mendoza led a team of researchers who collected surveys measuring access to food and compared those to clinical and laboratory data from the medical records of HIV-positive patients (ages 2 to 6) in the Botswana clinic. More than three-quarters of the participants had poor access to food, compared to 37% in the Texas Children’s study. Yet, the association between food access and CD4 counts was the same – children with poor access to food had more advanced HIV infection.

While further research is needed, Mendoza believes nutritional aid – including fortified food rations – could help HIV-positive children in Sub-Saharan Africa live longer, healthier lives. He plans to share his research results with groups and organizations who work in global health nutrition and HIV, as well as other researchers. Mendoza is also seeking funding for a future study which would develop an intervention to prevent and reduce food insecurity among HIV+ children and measure the impact on clinical outcomes.

“My hope is that this research will be used to optimize food and nutrition aid to this region,” Mendoza said. “Providing medications without addressing food access may not allow children to remain healthy or recover as quickly as we would like. Hopefully, this will help HIV healthcare workers secure resources specifically for pediatric nutrition.”

Media who would like to arrange an interview with Dr. Jason Mendoza should contact Seattle Children’s PR team at 206-987-4500 or