Measuring food and nutrition security: tools and considerations for use among people living with HIV

Exploring current nutritional programming and resources available to people living with HIV in Canada: a scoping review

OBJECTIVE

The objective of this scoping review was to map the current literature and resources available on nutrition and food programming for people living with HIV in Canada. This review is phase 1 of a 4-phase project, called FoodNOW (Food to eNhance Our Wellness), a community-based nutritional needs assessment of people living with HIV in Nova Scotia, Canada.

INTRODUCTION

People living with HIV may experience nutritional challenges, including nutritional deficiencies associated with the virus, food insecurity, and nutrition-drug interactions. Nutritional programming is often required for optimal care for people living with HIV. The literature, however, has not been sufficiently mapped to create a comprehensive picture of available programming. This review has informed the development of subsequent study phases, and will contribute towards shaping and planning food programs, as well as evaluating the need for subsequent systematic reviews.

INCLUSION CRITERIA

This review considered literature focused on nutrition and food programming and resources in Canada for people living with HIV. People living with HIV of any age, sex, race, gender identity, or sexual orientation, as well as pregnant and lactating people, were included as the population of interest.

METHODS

The databases searched were MEDLINE (Ovid), CINAHL (EBSCO), Academic Search Premier (EBSCO), Social Services Abstracts (ProQuest), and Scopus. Sources of gray literature searched included government and organization websites, and Google searches. The database search was conducted in July 2021, and the gray literature searches were conducted in August and October 2021. Searches were limited to evidence published or translated in English. Two independent reviewers conducted title and abstract screening, and potentially relevant results were retrieved in full. Full-text screening and data extraction was conducted by 2 independent reviewers using a data extraction tool designed specifically for the scoping review objectives and research inclusion criteria, and any conflicts were resolved through discussion. Results are presented in both tabular and diagrammatic formats, with a narrative summary.

RESULTS

A total of 581 results were screened (published and gray literature). A total of 64 results were included in the review. The 6 reasons for exclusion at full-text review were i) not nutrition and food programming (n= 83), ii) not Canadian (n= 37), iii) duplicates (n= 22), iv) not focused on people living with HIV (n= 6), v) conference abstract (n= 1), and vi) not in English (n= 1). A total of 76 resources were located, as some of the 64 included sources offered more than 1 resource. The 76 resources were organized into 6 categories: i) charitable food provision (n = 21; 27.6%), ii) financial aid (n = 14; 18.4%), iii) nutrition care (n =12; 15.8%), iv) providing access to secondary sources (n= 10; 13.2%), v) food and nutrition expertise (n= 10; 13.2%), and vi) population health promotion (n= 9; 11.8%). Recommendations for future research and programming are discussed.

CONCLUSIONS

This scoping review demonstrates that current programming relies heavily on charitable food provision services for people living with HIV and that there is an unequal distribution of resources across Canada. Program expansion to target diverse populations with more equal distribution across Canada may improve overall health outcomes for people living with HIV. Future research is needed to evaluate the effectiveness of available programming and the needs of end users (people living with HIV and their supports). FoodNOW will build on these findings to further explore and address the needs of people living with HIV.

REVIEW REGISTRATION

Open Science Framework https://osf.io/97x3r.

Exploring current nutritional programming and resources available to people living with HIV/AIDs in Canada: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to map the current literature and resources available on nutrition and food programming for people living with HIV/AIDS in Canada. This review is phase 1 of a 4-phase, provincially funded project called FoodNOW (Food to eNhance Our Wellness) focused on nutritional assessment of people living with HIV/AIDS in Nova Scotia, Canada.

INTRODUCTION

People living with HIV/AIDS may experience nutritional challenges, including food insecurity and nutrition-drug interactions. Nutritional programming is required for optimal care for people living with HIV/AIDS, however, there is a lack of information within the literature about current nutrition and food programming in Canada. This proposed review will investigate available programming and gaps.

INCLUSION CRITERIA

This review will consider literature focused on nutrition and food programming and resources in Canada for people living with HIV/AIDS. People living with HIV/AIDS of any age, sex, race, gender identity, or sexual orientation, including pregnant and lactating people living with HIV/AIDS, will be included as population of interest.

METHODS

The following databases will be searched: MEDLINE (EBSCO), CINAHL (EBSCO), Academic Search Premier (EBSCO), Social Services Abstracts (ProQuest), and Scopus. Types of gray literature eligible for review include reports from service providers and online public newspaper articles written by, with, or about people living with HIV/AIDS. Two independent reviewers will assess each study and any conflicts will be resolved through discussion. Data will be extracted by 2 independent reviewers. Results will be presented in tabular or diagrammatic format, with a narrative summary.

Improving the measurement of food insecurity among people with HIV in South Africa: a psychometric examination

OBJECTIVE

Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80 % of households are moderately or severely food insecure. For people with HIV (PWH), food insecurity is associated with poor antiretroviral therapy adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge.

DESIGN

The current study examines the factor structure of the nine-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model.

SETTING

Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA.

PARTICIPANTS

Participants (n 440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorised as severely (n 250, 56·82 %) or moderately (n 107, 24·32 %) food insecure in the past 30 d.

RESULTS

Revised parallel analysis suggested a three-factor structure, which was inadmissible. A two-factor structure was examined but did not adequately fit the data. A two-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (comparative fit index = 0·995, standardised root mean square residual = 0·019). The two specific factors identified were: anxiety/insufficient quality and no food intake. Reliability was adequate (ω = 0·82).

CONCLUSIONS

Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilised in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.

Undernutrition of HEU infants in their first 1000 days of life: A case in the urban-low resource setting of Mukuru Slum, Nairobi, Kenya

BACKGROUND

According to the Lancet, the successful chemoprophylaxis and the introduction of lifelong antiretroviral therapy programs to eliminate mother to child transmission of HIV has promoted the rise in number of HIV exposed uninfected (HEU) infants. In resource limited settings, these infants are at an increased risk of undernutrition due to risk factors such as low birth weight, food insecurity, household composition, income and improper feeding patterns. As several other studies have suggested, the risk factors vary from one setting to another. This paper delved into reviewing the predisposing undernutrition factors in relation to HIV exposure among infants within the low resource urban setting of Mukuru Slum, in Nairobi, Kenya.

METHODS

A retrospective cohort study was performed on 160 mother/guardian-child pairs in Mukuru Slum, Nairobi, Kenya. Growth charts of the HIV exposed uninfected infants were studied against a control group of HIV unexposed uninfected infants (HUU). Interviews to collect information on socio economic status, household composition, HIV exposure, infant feeding practices and food insecurity related challenges were done. Data was analyzed using IBM SPSS version 20 and WHO anthroplus software. Descriptive statistics as well as Chi square, t-tests and multivariate analysis was done.

RESULTS

Stunting among the HIV exposed uninfected infants was the most common form of undernutrition. 38.9% of the HEU infants were severely stunted (LFAZ), while 5.6% of them were severely wasted (WFLZ), while 24.4% of them were severely underweight. The mean birth weights of the HEU infants (2.953kg ) was lower than the HUU (3.195kg). HIV exposure was associated with lower Weight for Length Z score (WFLZ), Weight for Age Z score (WFAZ), Length for Age Z score (LFAZ), BMI for Age Z score (BAZ) and Middle Upper Arm Circumference Z score (MUACZ) (p<0.001) . HEU infants were more likely to live in households with lesser number of adults (p=0.016) and higher number of children (p<0.001) as compared to the HUU. Although exclusive breastfeeding was upheld among all infants, the HEU were more likely to rely on Food by Prescription supplements (p<0.001) to meet their daily energy needs. Households with HEU infants were, however, less likely to receive food (p=0.041). Overall the largest effect sizes on undernutrition of all infants was found to be affected by the age of children (η p 2 =0.439; p<0.001) , sex (η p 2 =0.135; p=0.001) , HIV exposure (η p 2 =0.351; p<0.001) and food aid (η p 2 =0.083; p=0.021).

CONCLUSION

This study concluded that, HIV exposed uninfected infants in Mukuru were faced with a high undernutrition risk that was associated with HIV exposure, household composition, food aid and use of food by prescription supplements. These factors provide an insight when managing undernutrition among such infants in other resource limited settings. This study recommends future operational studies to inform HIV programs on exact ways to eliminate undernutrition among the rising number of HEU infants.

Associations of food insecurity and psychosocial measures with diet quality in adults aging with HIV

People aging with HIV face social stressors which may negatively affect their overall nutrition. Here, we assess relationships between self-reported measures of depression, perceived stress, social support, and food insecurity with diet quality in older adults with HIV. A retrospective analysis of self-reported data from parent study at The University of Alabama at Birmingham 1917 HIV Clinic was performed. The study sample consisted of sixty people living with HIV (PLWH) with controlled HIV infection (<50 copies/mL), aged 50 years or older who participated in a cross-sectional microbiome study. Dietary intake was measured using the NHANES 12-month Food Frequency Questionnaire (FFQ) and three Automated Self-Administered (ASA) 24-hr diet recalls to calculate diet quality scores using the Mediterranean Diet Score (MDS); alternative Healthy Eating Index (aHEI); and the Recommended Food Score (RFS) indices. Food insecurity was measured with the Food Security Questionnaire (FSQ). Participants completed the following psychosocial scales: (1) depression - Patient Health Questionnaire-8 (PHQ8); (2) perceived stress - Perceived Stress Scale (PSS-10); (3) social support - Multidimensional Scale of Perceived Social Support (MSPSS). Linear regression models were used to investigate relationships among variables controlling for gender and income. The cohort was characterized as follows: Mean age 56 ± 4.6 years, 80% African-American, and 32% women. Mean body mass index (BMI) was 28.4 ± 7.2 with 55% reporting food insecurity. Most participants reported having post-secondary education (53%), although 77% reported annual incomes <$20,000. Food insecurity was independently associated with measures of poor dietary intake: aHEI (β = -0.08, p = .02) and MDS (β = -0.23, p < 0.01) and with low dietary intake of fibre (β = -0.27, p = .04), vitamin E (β = -0.35, p = .01), folate (β = -0.31, p = .02), magnesium (β = -0.34, p = .01) and copper (β = -0.36, p = .01). These data indicate food insecurity is associated with poor diet quality among PLWH. Clinical interventions are needed to improve food access for PLWH of low SES.

Adequação normativa dos planos estaduais de segurança alimentar e nutricional no Brasil

Resumo: Com o intuito de analisar a adequação dos Planos Estaduais de Segurança Alimentar e Nutricional (PlanSAN) às normas estabelecidas pela Política Nacional de Segurança Alimentar e Nutricional (PNSAN), foi realizada pesquisa descritiva e documental, com coleta de dados entre agosto a outubro de 2016. O acesso aos planos foi realizado na página de Internet da Câmara Interministerial de Segurança Alimentar e Nutricional (CAISAN) ou dos governos estaduais, com coleta de informações complementares no âmbito dos estados. Todos os estados brasileiros aderiram ao Sistema de Segurança Alimentar e Nutricional (SISAN), entretanto menos da metade (13 estados, 48%) elaborou seus planos, destacando-se alguns aspectos: 5 (38%) dos PlanSAN tinham vigência correspondente ao plano plurianual do estado; 5 (38%) dos PlanSAN descreviam os requisitos orçamentários para execução das metas propostas; e 7 (54%) descreviam mecanismos de monitoramento do plano e apenas 2 (15%) definiam metodologia para monitoramento de segurança alimentar e nutricional. O menor tempo de existência da CAISAN e de adesão parecem estar relacionados com a inexistência de PlanSAN. Ainda que a maioria dos estados com planos atendam algumas normativas estabelecidas pela PNSAN, esses instrumentos tornam-se frágeis e pouco exequíveis quando não possuem vinculação orçamentária para suas metas. Pelo fato de a PNSAN ser estruturalmente intersetorial, a construção dos planos depende de um trabalho coletivo das diversas secretarias de governo. Reforça-se que os itens analisados foram todos normativos, o que implica necessidade do estabelecimento de mecanismos que garantam a sua adequada execução.

High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa

Background

Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes.

Methods

We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review.

Results

One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01).

Conclusions

Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.

Food Insecurity is Longitudinally Associated with Depressive Symptoms Among Homeless and Marginally-Housed Individuals Living with HIV

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.

Adherence to HIV and TB care and treatment, the role of food security and nutrition

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.