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Gagnon M, Payne A, Guta A, Bungay V. "Food engages people, as we know": health care and service providers' experiences of using food as an incentive in HIV care and support in British Columbia, Canada. AIDS Care 2023; 35:148-152. [PMID: 34903119 DOI: 10.1080/09540121.2021.2014780] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Food insecurity is widely documented among people living with HIV (PLWH) worldwide, and it presents significant challenges across the spectrum of HIV care and support. In North America, the prevalence of food insecurity among PLWH exceeds 50%. In the province of British Columbia (BC), it exceeds 65%. It comes as no surprise that food has become an essential tool in supporting and engaging with PLWH. Over the past decade, however, a shift has taken place, and food has become an incentive to boost uptake and outcomes of prevention, testing, treatment, and support. To explore this practice, we drew on a qualitative case study of incentives in the care and support of PLWH. This paper presents the findings of a targeted analysis of interviews (N = 25) that discuss food incentives and explores two main themes that shed light on this practice: (1) Using food to engage versus to incentivize and (2) Food is more beneficial and more ethical. Providers perceived food more positively than other incentives, despite the goal remaining somewhat the same. Incentives, such as cash or gift cards, were considered ethically problematic and less helpful (and potentially harmful), whereas food addressed a basic need and felt more ethical.
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Affiliation(s)
- Marilou Gagnon
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada.,School of Nursing, University of Victoria, Victoria, Canada
| | - Alayna Payne
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Adrian Guta
- School of Social Work, University of Windsor, Windsor, Canada
| | - Vicky Bungay
- Canada Research Chair in Gender, Equity and Community Engagement, School of Nursing, University of British Columbia, Vancouver, Canada
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Leiman DA, Cardona DM, Kupfer SS, Rosenberg J, Bocsi GT, Hampel H. American Gastroenterological Association Institute and College of American Pathologists Quality Measure Development for Detection of Mismatch Repair Deficiency and Lynch Syndrome Management. Gastroenterology 2022; 162:360-365. [PMID: 34666049 DOI: 10.1053/j.gastro.2021.09.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/02/2022]
Affiliation(s)
- David A Leiman
- Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina
| | - Diana M Cardona
- Department of Pathology, Duke University School of Medicine, Durham, North Carolina
| | - Sonia S Kupfer
- Section of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Gregary T Bocsi
- Department of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Heather Hampel
- Division of Human Genetics, The Ohio State University, Columbus, Ohio
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Tesfay FH, Javanparast S, Gesesew H, Mwanri L, Ziersch A. Characteristics and impacts ofSystematic review nutritional programmes to address undernutrition of adults living with HIV in sub-Saharan Africa: a systematic review of evidence. BMJ Open 2022; 12:e047205. [PMID: 34987036 PMCID: PMC8734022 DOI: 10.1136/bmjopen-2020-047205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Although some studies have identified various challenges affecting nutritional programmes to effectively tackle undernutrition among people living with HIV, evidence about the characteristics and impacts of these programmes on weight-related nutritional outcomes varies based on country contexts, specific programme goals and the implementation processes. This systematic review sought to synthesise evidence on the characteristics and impact of nutritional programmes on weight-related nutritional outcomes of people living with HIV in sub-Saharan Africa. DESIGN Systematic review. DATA SOURCES We searched for primary studies published in the following databases: Web of Science, Medline, Scopus, ScienceDirect, ProQuest and Google Scholar, supplemented by checking reference lists of included papers. ELIGIBILITY CRITERIA Studies published from 2005 to 10 July 2020 and reporting on the weight-related nutritional outcomes of undernourished people enrolled in nutritional programmes in HIV care in sub-Saharan Africa were included. DATA EXTRACTION AND SYNTHESIS Data were extracted using a data extraction proforma. Weight-related nutritional outcomes of people living with HIV before and after enrolment in a nutritional programme were compared and narratively synthesised. RESULTS Sixteen studies assessing the impact of nutritional programmes in HIV care on weight-related nutritional outcomes were included. Of these, 13 examined nutritional programmes implemented in health facilities and the remaining three were delivered outside of health facilities. Nutritional recovery (defined differently in the studies) ranged from 13.1% to 67.9%. Overall programme failure rate, which included default after enrolment in a nutritional programme or non-response, ranged from 37.6% to 48.0%. More specifically, non-response to a nutritional programme ranged from 21.0% to 67.4% and default from the programme ranged from 19.0% to 70.6%. Key sociodemographic, clinical and nutritional characteristics that affect nutritional recovery, non-response and default were also identified. CONCLUSIONS AND RECOMMENDATIONS Nutritional programmes in HIV care have led to some improvements in weight-related nutritional outcomes among people living with HIV. However, the programmes were characterised by a high magnitude of default and non-response. To improve desired weight-related nutritional outcomes of people living with HIV, a holistic approach that addresses longer-term determinants of undernutrition is needed. PROSPERO REGISTRATION NUMBER CRD42020196827.
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Affiliation(s)
- Fisaha Haile Tesfay
- Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- School of Public Health, Mekelle University, Mekelle, Tigray, Ethiopia
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Sara Javanparast
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Anna Ziersch
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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Mate A, Reyes-Goya C, Santana-Garrido Á, Sobrevia L, Vázquez CM. Impact of maternal nutrition in viral infections during pregnancy. Biochim Biophys Acta Mol Basis Dis 2021; 1867:166231. [PMID: 34343638 PMCID: PMC8325560 DOI: 10.1016/j.bbadis.2021.166231] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/05/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022]
Abstract
Other than being a physiological process, pregnancy is a condition characterized by major adaptations of maternal endocrine and metabolic homeostasis that are necessary to accommodate the fetoplacental unit. Unfortunately, all these systemic, cellular, and molecular changes in maternal physiology also make the mother and the fetus more prone to adverse outcomes, including numerous alterations arising from viral infections. Common infections during pregnancy that have long been recognized as congenitally and perinatally transmissible to newborns include toxoplasmosis, rubella, cytomegalovirus, and herpes simplex viruses (originally coined as ToRCH infections). In addition, enterovirus, parvovirus B19, hepatitis virus, varicella-zoster virus, human immunodeficiency virus, Zika and Dengue virus, and, more recently, coronavirus infections including Middle Eastern respiratory syndrome (MERS) and severe acute respiratory syndrome (SARS) infections (especially the novel SARS-CoV-2 responsible for the ongoing COVID-19 pandemic), constitute relevant targets for current research on maternal-fetal interactions in viral infections during pregnancy. Appropriate maternal education from preconception to the early postnatal period is crucial to promote healthy pregnancies in general and to prevent and/or reduce the impact of viral infections in particular. Specifically, an adequate lifestyle based on proper nutrition plans and feeding interventions, whenever possible, might be crucial to reduce the risk of virus-related gestational diseases and accompanying complications in later life. Here we aim to provide an overview of the emerging literature addressing the impact of nutrition in the context of potentially harmful viral infections during pregnancy.
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Affiliation(s)
- Alfonso Mate
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain.
| | - Claudia Reyes-Goya
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain
| | - Álvaro Santana-Garrido
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
| | - Luis Sobrevia
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Cellular and Molecular Physiology Laboratory (CMPL), Department of Obstetrics, Division of Obstetrics and Gynaecology, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile; Medical School (Faculty of Medicine), São Paulo State University (UNESP), Brazil; University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4029, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen (UMCG), 9713GZ Groningen, the Netherlands
| | - Carmen M Vázquez
- Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, 41012 Sevilla, Spain; Epidemiología Clínica y Riesgo Cardiovascular, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocío/Consejo Superior de Investigaciones Científicas/Universidad de Sevilla, 41013 Sevilla, Spain
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5
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Schott E, Rezende FAC, Priore SE, Ribeiro AQ, Franceschini SDCC. Methodologies for assessing the household food availability in the context of food (in)security: a systematic review. CIENCIA & SAUDE COLETIVA 2021; 25:2677-2685. [PMID: 32667550 DOI: 10.1590/1413-81232020257.29342018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/26/2018] [Indexed: 11/21/2022] Open
Abstract
This article aims to identify the methods used to assess household food availability in studies on food and nutritional security and to discuss its methodological aspects. Systematic review elaborated according to the PRISMA method. We searched at PubMed; Scielo and Lilacs databases, and studies that used methods of assessing the availability of food at home were included. In the end, 19 papers composed the review. Food availability was predominantly assessed for a seven days period and from a single data measurement. Other variables were also observed in the studies, such as socio-demographic data and expenditure on food. Among the limitations to assess the food availability at home, we can highlight the difficulty in measuring the food distribution among family members and the lack of information on the variability of this availability. Such assessment can be improved by investigating the strengths and weaknesses of the instruments for greater detail and accuracy of the information. We recommend the development and validation of specific instruments capable of effectively measure the food availability at the household level.
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Affiliation(s)
- Eloise Schott
- Curso de Nutrição, Universidade Federal do Tocantins. Quadra 109 Norte Avenida NS 15, Plano Diretor Norte. 77001-090 Palmas TO Brasil.
| | - Fabiane Aparecida Canaan Rezende
- Curso de Nutrição, Universidade Federal do Tocantins. Quadra 109 Norte Avenida NS 15, Plano Diretor Norte. 77001-090 Palmas TO Brasil.
| | - Silvia Eloiza Priore
- Departamento de Nutrição e Saúde, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Viçosa. Viçosa MG Brasil
| | - Andréia Queiroz Ribeiro
- Departamento de Nutrição e Saúde, Centro de Ciências Biológicas e da Saúde, Universidade Federal de Viçosa. Viçosa MG Brasil
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Koyratty N, Jones AD, Schuster R, Kordas K, Li CS, Mbuya MNN, Boateng GO, Ntozini R, Chasekwa B, Humphrey JH, Smith LE. Food Insecurity and Water Insecurity in Rural Zimbabwe: Development of Multidimensional Household Measures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6020. [PMID: 34205143 PMCID: PMC8199942 DOI: 10.3390/ijerph18116020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022]
Abstract
Background: With millions of people experiencing malnutrition and inadequate water access, FI and WI remain topics of vital importance to global health. Existing unidimensional FI and WI metrics do not all capture similar multidimensional aspects, thus restricting our ability to assess and address food- and water-related issues. Methods: Using the Sanitation, Hygiene and Infant Nutrition Efficacy (SHINE) trial data, our study conceptualizes household FI (N = 3551) and WI (N = 3311) separately in a way that captures their key dimensions. We developed measures of FI and WI for rural Zimbabwean households based on multiple correspondence analysis (MCA) for categorical data. Results: Three FI dimensions were retained: 'poor food access', 'household shocks' and 'low food quality and availability', as were three WI dimensions: 'poor water access', 'poor water quality', and 'low water reliability'. Internal validity of the multidimensional models was assessed using confirmatory factor analysis (CFA) with test samples at baseline and 18 months. The dimension scores were associated with a group of exogenous variables (SES, HIV-status, season, depression, perceived health, food aid, water collection), additionally indicating predictive, convergent and discriminant validities. Conclusions: FI and WI dimensions are sufficiently distinct to be characterized via separate indicators. These indicators are critical for identifying specific problematic insecurity aspects and for finding new targets to improve health and nutrition interventions.
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Affiliation(s)
- Nadia Koyratty
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Andrew D. Jones
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA;
| | - Roseanne Schuster
- Center for Global Health, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85281, USA;
| | - Katarzyna Kordas
- Department of Epidemiology and Environmental Health, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA; (N.K.); (K.K.)
| | - Chin-Shang Li
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14214, USA;
| | | | - Godfred O. Boateng
- Department of Kinesiology, College of Nursing and Health Innovations, The University of Texas at Arlington, Arlington, TX 76019, USA;
| | - Robert Ntozini
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
| | - Jean H. Humphrey
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Laura E. Smith
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe; (R.N.); (B.C.); (J.H.H.)
- Department of Population Medicine and Diagnostics, Cornell University, Ithaca, NY 14853, USA
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Validation of a six-item dietary calcium screening tool among HIV patients in China. Public Health Nutr 2021; 24:4786-4795. [PMID: 33820577 DOI: 10.1017/s1368980021001427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Individuals with HIV are at increased risk for osteoporosis. A healthy diet with adequate Ca is recommended to promote bone health. However, lengthy nutritional assessments pose barriers to routine screenings in clinical practice. This study aimed to examine the validity and reproducibility of a six-item dietary Ca screening tool among Chinese individuals with HIV. DESIGN We conducted a two time-point study in an outpatient setting. Volunteers self-administered the six-item tool upon enrolment and again at 1-month follow-up. At baseline, participants also completed a validated FFQ and surveys regarding demographic and clinical risk factors. SETTING Beijing, China; Shenzhen, Guangdong, China. PARTICIPANTS Upon enrolment, 127 individuals with HIV participated in the study, of whom 83 completed the follow-up screening. RESULTS Mean age of participants was 35·2 (sd 9·3) years, average BMI was 22·8 (sd 3·8) kg/m2 and 89 % were men. Among the participants, 54·7 % reported Ca intake less than 800 mg/d. The six-item tool demonstrated fair-to-moderate relative validity with a correlation of 0·39 and 75·7 % of subjects classified in same/adjacent quartiles as the reference, and moderate-to-good reproducibility with a correlation of 0·60 and 83·1 % of subjects classified in same/adjacent quartiles. Finally, receiver operating characteristic analyses yielded a sensitivity of 87·0 % and a specificity of 39·4 % with optimised cut-off level. CONCLUSIONS The six-item tool presented adequate validity and reproducibility to identify individuals with low Ca intake among the target population, providing a convenient instrument for categorising Ca intake in clinical practice, prompting referrals for further assessment, and raising awareness of dietary Ca in bone disease prevention.
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8
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Onono M, Nanda K, Heller KB, Taylor D, Yacobson I, Heffron R, Kasaro MP, Louw CE, Nhlabasti Z, Palanee-Phillips T, Smit J, Wakhungu I, Gichangi PB, Mugo NR, Morrison C, Baeten JM. Comparison of pregnancy incidence among African women in a randomized trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) or a levonorgestrel (LNG) implant for contraception. Contracept X 2020; 2:100026. [PMID: 32577615 PMCID: PMC7301167 DOI: 10.1016/j.conx.2020.100026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective was to address bias in contraception efficacy studies through a randomized study trial of intramuscular depot medroxyprogesterone acetate (DMPA-IM), a copper intrauterine device (IUDs) and a levonorgestrel (LNG) implant. STUDY DESIGN We analyzed data from the Evidence for Contraceptive Options and HIV Outcomes Trial, which assessed HIV incidence among 7829 women from 12 sites in eSwatini, Kenya, South Africa and Zambia seeking effective contraception and who consented to be randomized to DMPA-IM, copper IUD or LNG implant. We used Cox proportional hazards regression adjusted for condom use to compare pregnancy incidence during both perfect and typical (i.e., allowing temporary interruptions) use. RESULTS A total of 7710 women contributed to this analysis. Seventy pregnancies occurred during perfect and 85 during typical use. There was no statistically significant difference in perfect use pregnancy incidence among the methods: 0.61 per 100 woman-years for DMPA-IM [95% confidence interval (CI) 0.36-0.96], 1.06 for copper IUD (95% CI 0.72-1.50) and 0.63 for LNG implants (95% CI 0.39-0.96). Typical use pregnancy rates were also largely similar: 0.87 per 100 woman-years for DMPA-IM (95% CI 0.58-1.25), 1.11 for copper IUD (95% CI 0.77-1.54) and 0.63 for LNG implants (95% CI 0.39-0.96). CONCLUSIONS In this randomized trial of highly effective contraceptive methods among African women, both perfect and typical use resulted in low pregnancy rates. Our findings provide strong justification for improving access to a broader range of longer-acting contraceptive options including LNG implants and copper IUD for African women. IMPLICATIONS STATEMENT Data from this study support recommendations to providers, policy makers and patients that all of these methods provide safe and highly effective contraception for African women.
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Affiliation(s)
- Maricianah Onono
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
| | | | | | | | | | | | | | - Cheryl E. Louw
- Madibeng Centre for Research, Brits, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - Zelda Nhlabasti
- Family Life Association of eSwatini & ICAP at Columbia University, eSwatini
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
| | - Jenni Smit
- University of the Witwatersrand, Durban, South Africa
| | - Imelda Wakhungu
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
| | - Peter B. Gichangi
- International Center for Reproductive Health, Kenya
- Technical University of Mombasa, Mombasa, Kenya
| | - Nelly R. Mugo
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
- University of Washington, Seattle, USA
| | | | | | - for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium
- Kenya Medical Research Institute Center for Microbiology Research, P.O. Box 19464-00202, Nairobi, Kenya
- FHI 360, Durham, USA
- University of Washington, Seattle, USA
- UNC Global Projects Zambia & University of North Carolina at Chapel Hill, Zambia
- Madibeng Centre for Research, Brits, South Africa
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
- Family Life Association of eSwatini & ICAP at Columbia University, eSwatini
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
- University of the Witwatersrand, Durban, South Africa
- International Center for Reproductive Health, Kenya
- Technical University of Mombasa, Mombasa, Kenya
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Knight L, Schatz E, Lewis KR, Mukumbang FC. 'When you take pills you must eat': Food (in)security and ART adherence among older people living with HIV. Glob Public Health 2019; 15:97-110. [PMID: 31318639 DOI: 10.1080/17441692.2019.1644361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
South Africa has increasing numbers of persons living with HIV on antiretroviral treatment (ART). There is evidence for a relationship between food, food security and HIV. Despite increasing rates of people older than 50 living with HIV coinciding with greater levels of co-morbidity, the existing research is largely limited to those aged 15-49 years. In this paper, we therefore explore how older people living with HIV (OPLWH) in two urban communities within South Africa negotiate and ensure they have sufficient access to food and how food insecurity may affect their retention in care and ART adherence. This study used exploratory qualitative semi-structured in-depth interviews with 23 OPLWH to collect data in isiXhosa. Data were analysed using thematic content analysis. Factors at the community, household and individual levels influence (a) access to sufficient and quality food, and (b) beliefs about ART and food based on (mis)understandings of messaging from health care providers. The results demonstrate the need to explore further and clarify the nutritional guidelines that OPLWH receive from providers to ensure this does not result in reduced adherence or retention in care. They also demonstrate the role that social welfare and family or kin obligations plays in ensuring the food security of OPLWH.
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Affiliation(s)
- Lucia Knight
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Enid Schatz
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Kaleea R Lewis
- Department of Public Health, School of Health Professions, University of Missouri, Columbia, MO, USA
| | - Ferdinand C Mukumbang
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
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10
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Jefferson KA, Kersanske LS, Wolfe ME, Braunstein SL, Haardörfer R, Des Jarlais DC, Campbell ANC, Cooper HL. Place-based predictors of HIV viral suppression and durable suppression among heterosexuals in New York city. AIDS Care 2018; 31:864-874. [PMID: 30477307 DOI: 10.1080/09540121.2018.1545989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Scant research has explored place-based correlates of achieving and maintaining HIV viral load suppression among heterosexuals living with HIV. We conducted multilevel analyses to examine associations between United Hospital Fund (UHF)-level characteristics and individual-level viral suppression and durable viral suppression among individuals with newly diagnosed HIV in New York City (NYC) who have heterosexual HIV transmission risk. Individual-level independent and dependent variables came from NYC's HIV surveillance registry for individuals diagnosed with HIV in 2009-2013 (N = 3,159; 57% virally suppressed; 36% durably virally suppressed). UHF-level covariates included measures of food distress, demographic composition, neighborhood disadvantage and affluence, healthcare access, alcohol outlet density, residential vacancy, and police stop and frisk rates. We found that living in neighborhoods where a larger percent of residents were food distressed was associated with not maintaining viral suppression. If future research should confirm this is a causal association, community-level interventions targeting food distress may improve the health of people living with HIV and reduce the risk of forward transmission.
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Affiliation(s)
- Kevin A Jefferson
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
| | - Laura S Kersanske
- b New York City Department of Health and Mental Hygiene , Queens , USA
| | - Mary E Wolfe
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
| | | | - Regine Haardörfer
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
| | | | - Aimee N C Campbell
- d Department of Psychiatry, New York State Psychiatric Institute , Columbia University Medical Center , New York , USA
| | - Hannah Lf Cooper
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
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Chintalapudi N, Hamela G, Mofolo I, Maman S, Hosseinipour MC, Hoffman IF, Flax VL. Infant and Young Child Feeding Decision Making and Practices: Malawian Mothers' and Fathers' Roles in the Context of HIV. J Hum Lact 2018; 34:68-76. [PMID: 28841399 PMCID: PMC6667220 DOI: 10.1177/0890334417719245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies in low- and middle-income countries have examined the roles of couples in infant and young child feeding decision making and practices, and there is no corresponding data in the context of human immunodeficiency virus (HIV). Research aim: This study aimed to explore mothers' and fathers' perceptions of their roles in feeding decision making and practices. METHODS The authors conducted in-depth interviews with 15 mothers and their male partners, recruited from the catchment areas of two urban and two rural government clinics in Lilongwe District, Malawi. The mothers were ≥ 18 years of age, were HIV positive, and had a child < 24 months of age. Twelve of the 15 fathers were also HIV positive. The interviews were analyzed using content analysis. RESULTS Mothers were responsible for child care, including breastfeeding and complementary feeding. Fathers provided monetary support for purchasing food and offered verbal support to encourage mothers to implement recommended feeding practices. Many fathers found it difficult to support adequate complementary feeding because of household food insecurity. Mothers were advised on child feeding during prevention of mother-to-child transmission clinic visits. No fathers in this study accompanied women to clinic appointments, so they were less well-informed about feeding than mothers. Fathers usually deferred to mothers in feeding decision making. One-third of mothers wanted fathers to be more involved in child feeding. CONCLUSION Malawian mothers' and fathers' roles in feeding decision making in the context of HIV align with local gender norms. Strategies are needed to improve fathers' knowledge of and involvement in child feeding, as desired by mothers.
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Affiliation(s)
- Nainisha Chintalapudi
- 1 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Suzanne Maman
- 3 Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Mina C Hosseinipour
- 2 UNC Project-Malawi, Lilongwe, Malawi.,4 Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Irving F Hoffman
- 2 UNC Project-Malawi, Lilongwe, Malawi.,4 Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Valerie L Flax
- 1 Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.,5 RTI International, Research Triangle Park, NC, USA
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12
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Idrisov B, Lunze K, Cheng DM, Blokhina E, Gnatienko N, Patts GJ, Bridden C, Kleinman RE, Weiser SD, Krupitsky E, Samet JH. Food Insecurity, HIV Disease Progression and Access to Care Among HIV-Infected Russians not on ART. AIDS Behav 2017; 21:3486-3495. [PMID: 28822002 PMCID: PMC5705384 DOI: 10.1007/s10461-017-1885-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Food insecurity (FI) has been associated with HIV disease progression among people on antiretroviral therapy (ART), presumably a consequence of poor medication adherence. We assessed whether there is a longitudinal association between FI and two primary outcomes reflecting on HIV disease progression (i.e., CD4 count and time to ART initiation) among people not on ART. Analyses used linear mixed effects and Cox models controlling for confounders. In this cohort (n = 310) FI was common (53%). Most (71.3%) reported past month heavy alcohol use and 37.1% reported past month injection drug use. Only 50 participants initiated ART during the study and mean time to ART was 128 days (SD 120). There were no significant differences in CD4 cell count between the groups with mild/moderate FI or severe FI versus those with no FI [adjusted mean difference, mild/moderate insecurity versus no FI -32.5 (95% CI -94.3, 29.3); severe versus no FI -45.5 (95% CI -124.1, 33.0); global p = 0.42]. We found no significant association between FI and longer time to ART initiation (p = 0.36). Food security is a desirable goal for overall health and shown beneficial for those on ART, however it does not appear to be associated with HIV disease progression among those with high prevalence of substance use and not yet on ART.
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Affiliation(s)
- Bulat Idrisov
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Karsten Lunze
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Elena Blokhina
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia
| | - Natalia Gnatienko
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Gregory J Patts
- Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
| | - Carly Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ronald E Kleinman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease and Global Medicine, Department of Medicine, UCSF, San Francisco, USA
| | - Evgeny Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St. Petersburg, Russia
- Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2nd Floor, Boston, MA, 02118, USA.
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
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13
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Natamba BK, Mehta S, Achan J, Stoltzfus RJ, Griffiths JK, Young SL. The association between food insecurity and depressive symptoms severity among pregnant women differs by social support category: a cross-sectional study. MATERNAL & CHILD NUTRITION 2017; 13:e12351. [PMID: 27507230 PMCID: PMC6865987 DOI: 10.1111/mcn.12351] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 12/01/2022]
Abstract
Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied among Ugandan pregnant women with low vs. high SS. Cross-sectional data were collected among 403 pregnant women in northern Uganda. SS was assessed using an eight-item version of the Duke-UNC functional SS scale. FI and depressive symptoms were assessed by, respectively, the individually focused FI scale and the Center for Epidemiologic Studies-Depression scale. Women were categorized into two SS groups, based on scoring < or ≥ to the median SS value. Multivariate linear regression models indicated an independent association between FI and depressive symptoms severity. The association between FI and depressive symptoms severity was moderated by SS i.e. was stronger among women in the low SS category (adjusted beta (95%CI): 0.91 (0.55; 1.27)) than for women belonging to the high SS group (0.53 (0.28; 0.78)) (adjusted p value for interaction = 0.026). There is need for longitudinal or interventional studies among pregnant women living in northern Uganda or similar contexts to examine the temporal sequence of the associations among food insecurity, depressive symptoms severity and social support. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Barnabas K. Natamba
- Department of Epidemiology, Harvard TH Chan School of Public HealthHarvard UniversityCambridgeMassachusettsUSA
- Department of Public Health, Faculty of MedicineGulu UniversityGuluUganda
| | - Saurabh Mehta
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
| | - Jane Achan
- Disease Control and Elimination ThemeMedical Research CouncilBanjulThe Gambia
| | | | - Jeffrey K. Griffiths
- Feed the Future Innovation Lab on Nutrition, Friedman School of Nutritional Sciences and PolicyTufts UniversityMedfordMassachusettsUSA
- Department of Public Health and Community MedicineTufts University Schools of Medicine, Veterinary Medicine, Nutrition and EngineeringMedfordMassachusettsUSA
| | - Sera L. Young
- Department of Population Medicine and Diagnostic SciencesCornell UniversityIthacaNew YorkUSA
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14
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Cox J, Hamelin AM, McLinden T, Moodie EEM, Anema A, Rollet-Kurhajec KC, Paradis G, Rourke SB, Walmsley SL, Klein MB. Food Insecurity in HIV-Hepatitis C Virus Co-infected Individuals in Canada: The Importance of Co-morbidities. AIDS Behav 2017; 21:792-802. [PMID: 26912217 PMCID: PMC5306219 DOI: 10.1007/s10461-016-1326-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While research has begun addressing food insecurity (FI) in HIV-positive populations, knowledge regarding FI among individuals living with HIV-hepatitis C virus (HCV) co-infection is limited. This exploratory study examines sociodemographic, socioeconomic, behavioral, and clinical factors associated with FI in a cohort of HIV-HCV co-infected individuals in Canada. We analyzed longitudinal data from the Food Security and HIV-HCV Co-infection Study of the Canadian Co-infection Cohort collected between November 2012-June 2014 at 15 health centres. FI was measured using the Household Food Security Survey Module and classified using Health Canada criteria. Generalized estimating equations were used to assess factors associated with FI. Among 525 participants, 59 % experienced FI at their first study visit (baseline). Protective factors associated with FI (p < 0.05) included: enrolment at a Quebec study site (aOR: 0.42, 95 % CI: 0.27, 0.67), employment (aOR: 0.55, 95 % CI: 0.35, 0.87), and average personal monthly income (aOR per $100 CAD increase: 0.98, 95 % CI: 0.97, 0.99). Risk factors for FI included: recent injection drug use (aOR: 1.98, 95 % CI: 1.33, 2.96), trading away food (aOR: 5.23, 95 % CI: 2.53, 10.81), and recent experiences of depressive symptoms (aOR: 2.11, 95 % CI: 1.48, 3.01). FI is common in this co-infected population. Engagement of co-infected individuals in substance use treatments, harm reduction programs, and mental health services may mitigate FI in this vulnerable subset of the HIV-positive population.
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Affiliation(s)
- Joseph Cox
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada.
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada.
- CIHR Canadian HIV Trials Network, Vancouver, BC, Canada.
| | - Anne-Marie Hamelin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Taylor McLinden
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Aranka Anema
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Boston Children's Hospital, Boston, MA, USA
| | | | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Sean B Rourke
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- The Ontario HIV Treatment Network, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sharon L Walmsley
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Marina B Klein
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
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15
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Anema A, Fielden SJ, Shurgold S, Ding E, Messina J, Jones JE, Chittock B, Monteith K, Globerman J, Rourke SB, Hogg RS. Association between Food Insecurity and Procurement Methods among People Living with HIV in a High Resource Setting. PLoS One 2016; 11:e0157630. [PMID: 27487041 PMCID: PMC4972395 DOI: 10.1371/journal.pone.0157630] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/02/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE People living with HIV in high-resource settings suffer severe levels of food insecurity; however, limited evidence exists regarding dietary intake and sub-components that characterize food insecurity (i.e. food quantity, quality, safety or procurement) in this population. We examined the prevalence and characteristics of food insecurity among people living with HIV across British Columbia, Canada. DESIGN This cross-sectional analysis was conducted within a national community-based research initiative. METHODS Food security was measured using the Health Canada Household Food Security Scale Module. Logistic regression was used to determine key independent predictors of food insecurity, controlling for potential confounders. RESULTS Of 262 participants, 192 (73%) reported food insecurity. Sub-components associated with food insecurity in bivariate analysis included: < RDI consumption of protein (p = 0.046); being sick from spoiled/unsafe food in the past six months (p = 0.010); and procurement of food using non-traditional methods (p <0.05). In multivariable analyses, factors significantly associated with food insecurity included: procurement of food using non-traditional methods [AOR = 11.11, 95% CI: 4.79-25.68, p = <0.001]; younger age [AOR = 0.92, 95% CI: 0.86-0.96, p = <0.001]; unstable housing [AOR = 4.46, 95% CI: 1.15-17.36, p = 0.031]; household gross annual income [AOR = 4.49, 95% CI: 1.74-11.60, p = 0.002]; and symptoms of depression [AOR = 2.73, 95% CI: 1.25-5.96, p = 0.012]. CONCLUSIONS Food insecurity among people living with HIV in British Columbia is characterized by poor dietary quality and food procurement methods. Notably, participants who reported procuring in non-traditional manners were over 10 times more likely to be food insecure. These findings suggest a need for tailored food security and social support interventions in this setting.
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Affiliation(s)
- Aranka Anema
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America
- Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America
- Division of International Nutrition, Department of Food, Nutrition and Health, Faculty of Land and Food Systems University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Sarah J. Fielden
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susan Shurgold
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Erin Ding
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Jennifer Messina
- Immune Deficiency Clinic, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | | | | | - Ken Monteith
- Coalition des organismes communautaires québécois de lutte contre le sida, Montréal, Quebéc, Canada
| | | | - Sean B. Rourke
- Ontario HIV Treatment Network, Toronto, Ontario, Canada
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Robert S. Hogg
- HIV/AIDS Drug Treatment Program, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University; Burnaby, British Columbia, Canada
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16
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Brief Report: Food Insufficiency Is Associated With Lack of Sustained Viral Suppression Among HIV-Infected Pregnant and Breastfeeding Ugandan Women. J Acquir Immune Defic Syndr 2016; 71:310-5. [PMID: 26397935 PMCID: PMC4752388 DOI: 10.1097/qai.0000000000000860] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Supplemental Digital Content is Available in the Text. Food insecurity is associated with poor virologic outcomes, but this has not been studied during pregnancy and breastfeeding. We assessed sustained viral suppression from 8 weeks on antiretroviral therapy to 48 weeks postpartum among 171 pregnant and breastfeeding Ugandan women; 74.9% experienced food insufficiency. In multivariable analysis, food insufficiency [adjusted odds ratio (aOR) 0.38, 95% confidence interval (CI): 0.16 to 0.91], higher pretreatment HIV-1 RNA (aOR 0.55 per 10-fold increase, 95% CI: 0.37 to 0.82), and lopinavir/ritonavir versus efavirenz (aOR 0.49, 95% CI: 0.24 to 0.96) were associated with lower odds of sustained viral suppression. Interventions to address food security may improve virologic outcomes among HIV-infected women.
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17
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Reported quality of life of HIV-positive people in Maseru, Lesotho: The need to strengthen social protection programmes. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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18
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The Association Between Food Insufficiency and HIV Treatment Outcomes in a Longitudinal Analysis of HIV-Infected Individuals in New York City. J Acquir Immune Defic Syndr 2015; 69:329-37. [PMID: 25751230 DOI: 10.1097/qai.0000000000000596] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND To date, there have been few longitudinal studies of food insecurity among people living with HIV (PLWH). Food insufficiency (FI) is one dimension of the food insecurity construct that refers to periods of time during which individuals have an inadequate amount of food intake because of limited resources. The aim of this analysis was to examine the relationship between FI and HIV treatment outcomes among HIV-infected individuals in New York City (NYC). METHODS Associations between FI ("consistent"--food insufficient on both of the last 2 assessments, "inconsistent"--food insufficient on 1 of the last 2 assessments, or neither) and clinical indicators of HIV disease progression (viral load > 200 copies per milliliter, CD4 count < 200 cells per cubic millimeter) were analyzed for NYC Ryan White Part A food and nutrition program clients who were matched to the NYC HIV Surveillance Registry and completed 2 FI assessments between November 2011 and June 2013. RESULTS Among 2,118 PLWH in food and nutrition programs, 61% experienced consistent FI and 25% experienced inconsistent FI. In multivariate analyses controlling for sociodemographic characteristics, consistent FI was independently associated with unsuppressed viral load (adjusted odds ratio = 1.6, confidence interval: 1.1 to 2.5). Consistent FI was only associated with low CD4 counts at the bivariate level. CONCLUSIONS Future studies should examine biological, structural, and psychosocial factors that may explain the relationship between FI and HIV treatment outcomes to inform intervention development. Persistent FI among food and nutrition program clients suggests that services are needed to address underlying needs for financial stability (eg, vocational counseling) for PLWH.
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19
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Food Insecurity is Longitudinally Associated with Depressive Symptoms Among Homeless and Marginally-Housed Individuals Living with HIV. AIDS Behav 2015; 19:1527-34. [PMID: 25351185 DOI: 10.1007/s10461-014-0922-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Depression and food insecurity are prevalent among people with HIV (PLHIV) and contribute to poor HIV outcomes. Longitudinal data can help clarify the effect of food insecurity on depression among PLHIV in the United States. We assessed the longitudinal association of food insecurity with symptoms of depression using validated measures among participants living with HIV from the Research on Access to Care in the Homeless cohort in San Francisco. We followed 346 participants for a median of 28 months. Over half of participants (55.0 %) were food insecure and 35.8 % had symptoms of depression. In adjusted models, severe food insecurity in the previous period was associated with increased depressive symptom severity (b = 1.22; p < 0.001). The association remained statistically significant in models including participant fixed effects. Severe food insecurity was also longitudinally associated with a binary variable indicating probable depression. Efforts to increase access to and participation in food security safety net programs for PLHIV could improve depression.
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20
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McCoy SI, Buzdugan R, Mushavi A, Mahomva A, Cowan FM, Padian NS. Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study. BMC Public Health 2015; 15:420. [PMID: 25909583 PMCID: PMC4424582 DOI: 10.1186/s12889-015-1764-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. We examined the association between FI and women's uptake of services to prevent mother-to-child HIV transmission (MTCT) in Zimbabwe. METHODS We analyzed cross-sectional data collected in 2012 from women living in five of ten provinces. Eligible women were ≥16 years old, biological mothers of infants born 9-18 months before the interview, and were randomly selected using multi-stage cluster sampling. Women and infants were tested for HIV and interviewed about health service utilization during pregnancy, delivery, and post-partum. We assessed FI in the past four weeks using a subset of questions from the Household Food Insecurity Access Scale and classified women as living in food secure, moderately food insecure, or severely food insecure households. RESULTS The weighted population included 8,790 women. Completion of all key steps in the PMTCT cascade was reported by 49%, 45%, and 38% of women in food secure, moderately food insecure, and severely food insecure households, respectively (adjusted prevalence ratio (PRa) = 0.95, 95% confidence interval (CI): 0.90, 1.00 (moderate FI vs. food secure), PRa = 0.86, 95% CI: 0.79, 0.94 (severe FI vs. food secure)). Food insecurity was not associated with maternal or infant receipt of ART/ARV prophylaxis. However, in the unadjusted analysis, among HIV-exposed infants, 13.3% of those born to women who reported severe household food insecurity were HIV-infected compared to 8.2% of infants whose mothers reported food secure households (PR = 1.62, 95% CI: 1.04, 2.52). After adjustment for covariates, this association was attenuated (PRa = 1.42, 95% CI: 0.89, 2.26). There was no association between moderate food insecurity and MTCT in unadjusted or adjusted analyses (PRa = 0.68, 95% CI: 0.43, 1.08). CONCLUSIONS Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health.
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Affiliation(s)
- Sandra I McCoy
- University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA, 94704, USA.
| | - Raluca Buzdugan
- University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA, 94704, USA.
| | - Angela Mushavi
- Ministry of Health and Child Welfare, Mkwati Building Corner 5th Street and Livingstone Avenue, Harare, Zimbabwe.
| | - Agnes Mahomva
- Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe.
| | - Frances M Cowan
- Centre for Sexual Health and HIV Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe.
- University College London, London, UK.
| | - Nancy S Padian
- University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA, 94704, USA.
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21
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Measuring food and nutrition security: tools and considerations for use among people living with HIV. AIDS Behav 2014; 18 Suppl 5:S490-504. [PMID: 24297517 DOI: 10.1007/s10461-013-0669-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As an increasing number of countries implement integrated food and nutrition security (FNS) and HIV programs, global stakeholders need clarity on how to best measure FNS at the individual and household level. This paper reviews prominent FNS measurement tools, and describes considerations for interpretation in the context of HIV. There exist a range of FNS measurement tools and many have been adapted for use in HIV-endemic settings. Considerations in selecting appropriate tools include sub-types (food sufficiency, dietary diversity and food safety); scope/level of application; and available resources. Tools need to reflect both the needs of PLHIV and affected households and FNS program objectives. Generalized food sufficiency and dietary diversity tools may provide adequate measures of FNS in PLHIV for programmatic applications. Food consumption measurement tools provide further data for clinical or research applications. Measurement of food safety is an important, but underdeveloped aspect of assessment, especially for PLHIV.
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22
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Claros JM, de Pee S, Bloem MW. Adherence to HIV and TB care and treatment, the role of food security and nutrition. AIDS Behav 2014; 18 Suppl 5:S459-64. [PMID: 25092515 DOI: 10.1007/s10461-014-0870-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Food security and nutrition play an important role in HIV and TB care and treatment, including for improving treatment outcomes, adherence and uptake of HIV and TB care. This AIDS and behaviour supplement on "Adherence to HIV and TB care and treatment, the role of food security and nutrition" provides an overview of the current evidence and knowledge about the barriers to uptake and retention in HIV and TB treatment and care and on whether and how food and nutrition assistance can help overcome these barriers. It contains nine papers on three topic areas discussing: (a) adherence and food and nutrition security in context of HIV and TB, their definitions, measurement tools and the current situation; (b) food and nutrition insecurity as barriers to uptake and retention; and (c) food and nutrition assistance to increase uptake and retention in care and treatment. Future interventions in the areas of food security, nutrition and social protection for increasing access and adherence should be from an HIV sensitive lens, linking the continuum of care with health systems, food systems and the community, complementing existing platforms through partnerships and integrated services.
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Affiliation(s)
- Joan M Claros
- Nutrition and HIV/AIDS Policy Programme and Innovation Division, World Food Programme, Via Cesare Giulio Viola 68/70, 00148, Rome, Lazio, Italy,
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23
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Anema A, Kerr T, Milloy MJ, Feng C, Montaner JSG, Wood E. Relationship between hunger, adherence to antiretroviral therapy and plasma HIV RNA suppression among HIV-positive illicit drug users in a Canadian setting. AIDS Care 2014; 26:459-65. [PMID: 24015838 PMCID: PMC4064571 DOI: 10.1080/09540121.2013.832724] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
Food insecurity may be a barrier to achieving optimal HIV treatment-related outcomes among illicit drug users. This study therefore, aimed to assess the impact of severe food insecurity, or hunger, on plasma HIV RNA suppression among illicit drug users receiving antiretroviral therapy (ART). A cross-sectional Multivariate logistic regression model was used to assess the potential relationship between hunger and plasma HIV RNA suppression. A sample of n = 406 adults was derived from a community-recruited open prospective cohort of HIV-positive illicit drug users, in Vancouver, British Columbia (BC), Canada. A total of 235 (63.7%) reported "being hungry and unable to afford enough food," and 241 (59.4%) had plasma HIV RNA < 50 copies/ml. In unadjusted analyses, self-reported hunger was associated with lower odds of plasma HIV RNA suppression (Odds Ratio = 0.59, 95% confidence interval [CI]: 0.39-0.90, p = 0.015). In multivariate analyses, this association was no longer significant after controlling for socio-demographic, behavioral, and clinical characteristics, including 95% adherence (Adjusted Odds Ratio [AOR] = 0.65, 95% CI: 0.37-1.10, p = 0.105). Multivariate models stratified by 95% adherence found that the direction and magnitude of this association was not significantly altered by the adherence level. Hunger was common among illicit drug users in this setting. Although, there was an association between hunger and lower likelihood of plasma HIV RNA suppression, this did not persist in adjusted analyses. Further research is warranted to understand the social-structural, policy, and physical factors shaping the HIV outcomes of illicit drug users.
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Affiliation(s)
- Aranka Anema
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M-J. Milloy
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Cindy Feng
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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24
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Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada. PLoS One 2013; 8:e61277. [PMID: 23723968 PMCID: PMC3664561 DOI: 10.1371/journal.pone.0061277] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 03/11/2013] [Indexed: 11/21/2022] Open
Abstract
Objectives Little is known about the potential impact of food insecurity on mortality among people living with HIV/AIDS. We examined the potential relationship between food insecurity and all-cause mortality among HIV-positive injection drug users (IDU) initiating antiretroviral therapy (ART) across British Columbia (BC). Methods Cross-sectional measurement of food security status was taken at participant ART initiation. Participants were prospectively followed from June 1998 to September 2011 within the fully subsidized ART program. Cox proportional hazard models were used to ascertain the association between food insecurity and mortality, controlling for potential confounders. Results Among 254 IDU, 181 (71.3%) were food insecure and 108 (42.5%) were hungry. After 13.3 years of median follow-up, 105 (41.3%) participants died. In multivariate analyses, food insecurity remained significantly associated with mortality (adjusted hazard ratio [AHR] = 1.95, 95% CI: 1.07–3.53), after adjusting for potential confounders. Conclusions HIV-positive IDU reporting food insecurity were almost twice as likely to die, compared to food secure IDU. Further research is required to understand how and why food insecurity is associated with excess mortality in this population. Public health organizations should evaluate the possible role of food supplementation and socio-structural supports for IDU within harm reduction and HIV treatment programs.
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