Steven Y Hong1, Theresa J Fanelli, Anna Jonas, Justice Gweshe, Francina Tjituka, Heidi M B Sheehan, Christine Wanke, Norma Terrin, Michael R Jordan, Alice M Tang. 1. *Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA; †Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA; ‡Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia; §Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; and ‖Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
Abstract
OBJECTIVE: Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that uses the public health model of delivery. DESIGN: A cross-sectional study using a 1-time questionnaire and routinely collected pharmacy data. METHODS: Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence. RESULTS: Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% [odds ratio (OR), 3.84; 95% confidence interval (CI): 1.65 to 8.95]. Higher household health care spending (OR, 1.92; 95% CI, 1.02 to 3.57) and longer duration of ART (OR, 0.82; 95% CI: 0.70 to 0.97) were also associated with <80% MPR. CONCLUSIONS: Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.
OBJECTIVE: Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that uses the public health model of delivery. DESIGN: A cross-sectional study using a 1-time questionnaire and routinely collected pharmacy data. METHODS:Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence. RESULTS: Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% [odds ratio (OR), 3.84; 95% confidence interval (CI): 1.65 to 8.95]. Higher household health care spending (OR, 1.92; 95% CI, 1.02 to 3.57) and longer duration of ART (OR, 0.82; 95% CI: 0.70 to 0.97) were also associated with <80% MPR. CONCLUSIONS: Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.
Authors: Jonathan Shuter; Julie A Sarlo; Tina J Kanmaz; Richard A Rode; Barry S Zingman Journal: J Acquir Immune Defic Syndr Date: 2007-05-01 Impact factor: 3.731
Authors: Joseph Mamlin; Sylvester Kimaiyo; Stephen Lewis; Hannah Tadayo; Fanice Komen Jerop; Catherine Gichunge; Tomeka Petersen; Yuehwern Yih; Paula Braitstein; Robert Einterz Journal: Am J Public Health Date: 2008-12-04 Impact factor: 9.308
Authors: Jean B Nachega; Michael Hislop; David W Dowdy; Melanie Lo; Saad B Omer; Leon Regensberg; Richard E Chaisson; Gary Maartens Journal: J Acquir Immune Defic Syndr Date: 2006-09 Impact factor: 3.731
Authors: James H McMahon; Michael R Jordan; Karen Kelley; Silvia Bertagnolio; Steven Y Hong; Christine A Wanke; Sharon R Lewin; Julian H Elliott Journal: Clin Infect Dis Date: 2011-01-18 Impact factor: 9.079
Authors: Sheri D Weiser; Edward A Frongillo; Kathleen Ragland; Robert S Hogg; Elise D Riley; David R Bangsberg Journal: J Gen Intern Med Date: 2008-10-25 Impact factor: 5.128
Authors: David R Bangsberg; Edward P Acosta; Reena Gupta; David Guzman; Elise D Riley; P Richard Harrigan; Neil Parkin; Steven G Deeks Journal: AIDS Date: 2006-01-09 Impact factor: 4.177
Authors: M Martin; E Del Cacho; C Codina; M Tuset; E De Lazzari; J Mallolas; J-M Miró; J M Gatell; J Ribas Journal: AIDS Res Hum Retroviruses Date: 2008-10 Impact factor: 2.205
Authors: Bulat Idrisov; Karsten Lunze; Debbie M Cheng; Elena Blokhina; Natalia Gnatienko; Gregory J Patts; Carly Bridden; Ronald E Kleinman; Sheri D Weiser; Evgeny Krupitsky; Jeffrey H Samet Journal: AIDS Behav Date: 2017-12
Authors: Gregory J Patts; Debbie M Cheng; Nneka Emenyonu; Carly Bridden; Natalia Gnatienko; Christine A Lloyd-Travaglini; Christine Ngabirano; Tatiana Yaroslavtseva; Winnie R Muyindike; Sheri D Weiser; Evgeny M Krupitsky; Judith A Hahn; Jeffrey H Samet Journal: AIDS Behav Date: 2017-03
Authors: Mira Wang; Joshua D Miller; Shalean M Collins; Marianne V Santoso; Pauline Wekesa; Hideaki Okochi; Maricianah Onono; Sheri Weiser; Monica Gandhi; Sera L Young Journal: AIDS Behav Date: 2020-10
Authors: Nozipho Becker; Krishna C Poudel; Lorraine S Cordeiro; Aline G Sayer; Thokozile E Sibiya; Lindiwe N Sibeko Journal: PLoS One Date: 2021-08-26 Impact factor: 3.240