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<OL> <LI> To determine gaps in food safety knowledge among AIDS patients. We hypothesize that AIDS patients are not knowledgeable regarding prevention of foodborne illness due to the pathogens likely to harm them and that overall they will score fewer than 70% correct on an educational food safety survey specifically covering foodborne disease relevant to persons with AIDS. <LI> To determine if AIDS patients are receiving oral or written food safety educational information. We hypothesize that fewer than 70% and 50% of AIDS patients recall ever receiving oral and written educational food safety information, respectively. <LI> To create an educational and attractive intervention that <BR> i. Targets knowledge gaps identified among the AIDS patients<BR> ii. Is easily distributed to AIDS patients <BR>iii. Is language and educational level appropriate <BR>iv. Uses a novel illustrated comic book menu format <LI> To assess the impact of the comic book menu on knowledge of AIDS patients.<BR> i. We hypothesize that the intervention will increase food safety knowledge by at least 20% compared to their baseline knowledge. <BR>ii. We hypothesize that more than 70% of the AIDS patients who read the educational intervention will achieve a knowledge score greater than 80%. <LI> To assess the availability of educational materials with information on preventing foodborne illness in health care settings where AIDS patients receive care in the United States and to increase awareness of these free materials. We hypothesize that fewer than half of the healthcare providers that see at least five AIDS patients per month have educational written materials available to distribute to their patients and are unaware of existing free materials.
NON-TECHNICAL SUMMARY: The goal of this project is to provide food safety education to adult persons living with AIDS because they are at increased risk for foodborne illnesses. Nearly a half a million persons are living with AIDS in the United States and they are highly vulnerable to foodborne enteric infections (such as from eating dairy, meat and poultry, and vegetables) with the potential for substantial morbidity and mortality. This project will survey persons with AIDS in Chicago, New Orleans, and Puerto Rico to determine their baseline knowledge of food safety, develop and disseminate educational entertaining material (a comic book menu) that targets their knowledge gaps, and then survey this population again to determine if the educational intervention is effective at raising knowledge. The educational materials will be made available in English and Spanish. The study will also assess the availability of food safety educational material in healthcare offices where AIDS patients receive care in Chicago, New Orleans, and the island of Puerto Rico while raising awareness by these offices of the existing and newly created materials.
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APPROACH: A 15 minute voluntary survey will be created and will include questions assessing knowledge and behavior related to food safety and demographic characteristics. The survey will be administered in Spanish and English as appropriate. Patients will be excluded if they can not consent for themselves, do not speak either English or Spanish fluently, are prisoners, are younger than 18 years of age, or have >200 CD4 cells. Data analysis will be performed to determine the frequency of gaps in food safety knowledge in each of the three sites and overall. Risk factor analysis will be performed to explore possible associations between ethnicity, race, country of birth, age, sex, educational background, study site, and substance abuse. Univariate, bivariate, and multivariable analysis will be performed using logistic regression analysis. The comic book menu will be 12 pages in length, entertaining, instructive, and prepared in English and Spanish versions. It will emphasize the most substantial and clinically significant gaps in food safety and preparation knowledge observed among the patients with AIDS. A focus group of 5 HIV-infected patients will be held at each of the participating sites and their comments will be used to revise and improve the comic book menu. Study participants will be provided the comic book menu in the language of their choice (English or Spanish) and encouraged to read it. Beginning one month after the final distribution of the comic book menu, the surveys will be repeated and will include only the knowledge questions from the original survey along with questions determining whether the patients received and read the comic book menu, their enthusiasm for it, and exploring if and in what ways it may have led to any changes in their food safety-related behavior. Data analysis will determine whether the intervention significantly improved food safety-related knowledge by at least 20% overall compared to the baseline survey using the Wilcoxon signed-rank test. Acceptability will also be examined based on the analysis of data from the second survey that will ask whether they read the educational material and their perception of potential benefits. As a subanalysis, only the results of the survey for those persons who prepare their own food will be analyzed. We will also explore the data to examine factors associated with lack of food safety knowledge for each of the questions. We will obtain a statistical sample of healthcare providers that provide primary care for at least 5 AIDS patients in Chicago, New Orleans, and the island of Puerto Rico. A survey will be created that may be performed by a primary care provider or an office staff member as it will be verifying whether the office has at least 5 active AIDS patients in their care, has the CDC food safety brochure available on site for patients (and a copy of it will be included for their reference), has any other food safety specific educational material available on site for patients (and to specify), and a few other descriptive characteristics such as if the majority of their AIDS patients are uninsured.