The Impact of a Community-Based Intervention Including a Monthly Food Ration on Food Insecurity Among HIV-Positive Adults During the First Year of Antiretroviral Therapy

Food insecurity and level of depression among patients with chronic diseases, and associated factors during the COVID-19 lockdown: a cross-sectional study in rural Rwanda

OBJECTIVES

We aimed to describe access to food and symptoms of depression among patients with chronic diseases or their caregivers, and assess associated factors during the COVID-19 lockdown in rural Rwanda.

DESIGN

A cross-sectional study.

SETTING AND PARTICIPANTS

A stratified random sampling technique was used to recruit 220 patients enrolled in the HIV, non-communicable diseases, mental health, paediatric development clinic and oncology programmes in three rural districts of Rwanda.

OUTCOME MEASURES

Telephone-based interviews were conducted to collect data on the number of daily meals before and during the COVID-19, and depression was assessed using the Patient Health Questionnaire-9. We used logistic regression analysis to investigate factors associated with households reporting a reduction in daily meals and with the survey respondent reporting symptoms of depression.

RESULTS

Of the participants, 19.1% reported a reduction in daily number of meals for either adults or children in their households during lockdown and 24.6% had depression. Reporting a reduction in daily meals was associated with the district of residence and estimated household's monthly income. Self-reported depression was significantly associated with negative experiences during lockdown, including reporting feeling depressed or fear (AOR 4.82; 95% CI 2.08 to 11.21), loneliness (AOR 4.33; 95% CI 1.32 to 14.13), reduction in daily meals (AOR 4.15; 95% CI 1.56 to 11.00) and lack of access to healthcare (OR 3.29; 95% CI 1.32 to 8.23).

CONCLUSIONS

Our findings suggest that significant reduction in access to food affected rural Rwandans with chronic diseases during COVID-19 lockdown, and the lockdown effect varied by household's pre-pandemic level of vulnerability to food insecurity. Reduction in household meals, as well as other self-reported effects of the lockdown, were associated with worse psychological status of survey respondents. Economic and food support should be considered by governments and non-governmental organisations to protect those most vulnerable including patients with chronic diseases against the effects of pandemics and their associated containment measures.

Characteristics and clinical outcomes of patients presenting with advanced HIV disease in the "treat all" era: a retrospective cohort study from rural Rwanda

Background

In 2016 Rwanda adopted “treat all” where all patients with HIV are immediately eligible for ART regardless of disease progression. Despite widespread availability of treatment, it is unknown whether presentation with advanced HIV persists.

Methods

We conducted a retrospective cohort among patients aged ≥ 15 who enrolled in care between July 2016 and July 2018 in three rural Rwandan districts. We estimated the prevalence of advanced HIV, defined as presenting with CD4 count < 200 cells/mm³ or WHO stage 3 or 4, and compared baseline characteristics of patients with and without advanced HIV. We compared cumulative incidences and time to events using Chi squared tests and Cox proportional hazards models, respectively, for (a) viral load tests; (b) viral suppression; (c) death; and (d) treatment failure (a composite of death, lost to follow up, or virologic failure).

Results

Among 957 patients, 105 (11.0%) presented with advanced HIV. These patients were significantly more likely to have low body mass index, come from Burera district, be older, and be identified through inpatient settings rather than through voluntary or prenatal testing. Patients with advanced HIV had significantly higher risks of death at 12-months (9.5% vs 1.5%, p < 0.001) and 18-months (10.5% vs 1.9%, p < 0.001) and significantly higher risk of treatment failure at 12-months (21.9% vs. 14.2%, p = 0.037). After adjusting for confounders, patients with advanced HIV had still higher rates of death (adjusted Hazard ratio [aHR] = 4.4, 95% CI: 1.9, 10.2, p < 0.001) and treatment failure (aHR = 1.7, 95% CI: 1.1, 2.5, p = 0.017), but no difference in viral load testing (aHR = 1.1, 95% CI: 0.8, 1.5, p = 0.442) or viral suppression (aHR = 1.0, 95% CI: 0.8, 1.4, p = 0.949). When allowing for the hazard ratio to vary over time, patients with advanced HIV experienced elevated rates of treatment failure in the first six of enrollment, but not after nine months.

Conclusion

Presenting with advanced HIV remains common and is still associated with poor patient outcomes. Sensitization of the community to the benefits of early ART initiation, identification of patients with advanced HIV, and holistic support programs for the first 6 months of treatment may be needed to improve outcomes.

Food Insecurity Is Associated with the Quality of Diet of Non-Institutionalized Older Adults from a Southern Chilean Commune: A Cross-Sectional Study

As the population ages, greater attention to age-related health problems related to diet and lifestyles is needed. Here, we sought to evaluate the associations between demographic and clinical characteristics and food insecurity with the quality of diet of non-institutionalized elderly from a southern Chilean commune. We performed an analytical cross-sectional study in a sample of 376 older adults. Nutritional status was evaluated through anthropometric measurements. Quality of diet was determined by the healthy eating index (HEI), obtained through the frequency of consumption questionnaire. Socioeconomic, demographic, and lifestyle variables were also collected. Ordinal logistic and Poisson regression models were applied to study associations with quality of diet. The sample consisted of more women (81.6%) than men (18.4%). Most older adults were found to live in a situation of vulnerability or poverty (82.4%), with most having food security (65.7%). According to the HEI, only 14.1% had a good quality of diet, 83.8% had diet in need of improvement, and 2.1% had an unhealthy diet. There was an association of food insecurity and cardiovascular risk (according to waist circumference) with lower quality of diet categories. However, an association with the unhealthy quality of diet category was not confirmed with Poisson regression analysis, which was possibly due to the low number of subjects in that category (n = 8, 2.1%). Other modifiable factors like physical activity, hours of sleep, and polypharmacy were not associated with lower quality of diet categories. Socioeconomic status, which is a structural health determinant, was not associated with decreased quality of diet. Since this was a cross-sectional study performed on a small sample from a Chilean commune, directionality of associations cannot be discerned, and future longitudinal studies could aim to better characterize these associations in larger samples of elderly patients.