Understanding Hiv Patients’ Perceptions of Nutrition Education at Mulago National Referral Hospital, a Qualitative Study

Background Malnutrition is a prevalent and serious comorbidity among people living with HIV (PLHIV), affecting up to 69.1% of individuals in low- and middle-income countries. In Uganda, over 1.4 million people live with HIV, yet evidence on how inpatients at referral-level facilities perceive, understand, and engage with nutrition education remains critically limited. This study investigated HIV patients' perceptions of nutrition education at Mulago National Referral Hospital (MNRH), Uganda's largest tertiary HIV care facility, guided by the Health Belief Model (HBM). Methods A qualitative exploratory-descriptive design was employed. Seven HIV-positive adult inpatients were recruited through purposive sampling at MNRH. Data were collected via in-depth semi-structured interviews conducted in English or Luganda, audio-recorded, and transcribed verbatim. Thematic analysis followed Braun and Clarke's six-step framework using NVivo software, applying a hybrid deductive-inductive coding strategy anchored in HBM constructs. Trustworthiness was established through member checking, reflexive journaling, audit trail maintenance, and thick contextual description consistent with Lincoln and Guba's criteria. Results Three principal findings emerged. First, structured nutrition education was systemically absent from the inpatient HIV ward: six of seven participants reported receiving no dietary counselling during admission, and no ward-based nutritionist was present—a pattern termed structural silence. Second, despite broadly positive attitudes toward nutrition and recognition of its importance for immune recovery and antiretroviral therapy (ART) effectiveness, patients lacked practical dietary guidance, revealing a critical self-efficacy gap. Third, barriers to nutritional uptake were intersecting and cumulative, spanning health-system deficiencies, food insecurity, economic hardship, caregiver knowledge gaps, and clinical instability. Caregivers, present in six of seven cases, were consistently identified as an underutilised educational resource. Conclusions Structured nutrition education is critically absent from MNRH's HIV inpatient care, reflecting a failure to translate national policy into ward-level practice. Findings have direct implications for referral-level HIV facilities across sub-Saharan Africa. MNRH should appoint a dedicated ward-based nutritionist, embed nutrition messaging within routine clinical procedures, include caregivers systematically in counselling, and establish food support mechanisms for vulnerable patients. The Ministry of Health should revise Nutrition Assessment, Counselling and Support (NACS) monitoring indicators to measure educational quality alongside assessment rates.