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Talathi R, Anekwe CV, Toribio M. Epidemiology of obesity among people with HIV. Curr Opin HIV AIDS 2024; 19:1-5. [PMID: 37916907 PMCID: PMC10842423 DOI: 10.1097/coh.0000000000000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW People with HIV (PWH) on antiretroviral therapy (ART) globally are disproportionately affected by obesity, with prevalence rates highest among women with HIV. The purpose of this review is to discuss rates of obesity, factors associated with obesity, and adverse consequences of obesity among PWH. RECENT FINDINGS Among PWH on ART, rates of obesity have increased over the last several decades and tend to be higher than the general population. Weight gain with the initiation of new ART regimens such as integrase strand transfer inhibitor (INSTI)-based regimens are thought to contribute to higher rates of obesity among PWH on ART. Other factors, such as sex and ethnicity, also are associated with obesity among PWH on ART. Higher obesity rates among PWH may contribute to heightened cardiometabolic disease risk and lower health-related quality of life. SUMMARY Prospective studies which identify factors associated with increased obesity prevalence and weight gain among PWH are necessary for the development and implementation of obesity prevention and treatment strategies among PWH on ART and, in turn, reduce the prevalence of obesity in this population.
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Affiliation(s)
- Ria Talathi
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chika V. Anekwe
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital Weight Center, Department of Medicine, Division of Endocrinology, Metabolism Unit, Boston, MA, USA
| | - Mabel Toribio
- Metabolism Unit, Division of Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Celeste-Villalvir A, Then-Paulino A, Armenta G, Jimenez-Paulino G, Palar K, Wallace DD, Derose KP. Exploring feasibility and acceptability of an integrated urban gardens and peer nutritional counselling intervention for people with HIV in the Dominican Republic. Public Health Nutr 2023; 26:3134-3146. [PMID: 37905447 PMCID: PMC10755388 DOI: 10.1017/s1368980023002264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Food security interventions with people living with HIV (PLHIV) are needed to improve HIV outcomes. This process evaluation of a pilot intervention involving urban gardening and peer nutritional counselling with PLHIV assesses feasibility, acceptability and implementation challenges to inform scale-up. DESIGN Mixed methods were used, including quantitative data on intervention participation and feasibility and acceptability among participants (n 45) and qualitative data from a purposive sample of participants (n 21). Audio-recorded interviews were transcribed and coded using a codebook developed iteratively. SETTING An HIV clinic in the northwest-central part of the Dominican Republic. RESULTS The intervention was feasible for most participants: 84 % attended a garden workshop and 71 % established an urban garden; 91 % received all three core nutritional counselling sessions; and 73 % attended the cooking workshop. The intervention was also highly acceptable: nearly, all participants (93-96 %) rated the gardening as 'helpful' or 'very helpful' for taking HIV medications, their mental/emotional well-being and staying healthy; similarly, high percentages (89-97 %) rated the nutrition counselling 'helpful' or 'very helpful' for following a healthy diet, reducing unhealthy foods and increasing fruit/vegetable intake. Garden barriers included lack of space and animals/pests. Transportation barriers impeded nutritional counselling. Harvested veggies were consumed by participants' households, shared with neighbours and family, and sold in the community. Many emphasised that comradery with other PLHIV helped them cope with HIV-related marginalisation. CONCLUSION An urban gardens and peer nutritional counselling intervention with PLHIV was feasible and acceptable; however, addressing issues of transportation, pests and space is necessary for equitable participation and benefit.
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Affiliation(s)
- Alane Celeste-Villalvir
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
| | - Amarilis Then-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
| | - Gipsy Jimenez-Paulino
- Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Av. Alma Mater, Santo Domingo, Dominican Republic
| | - Kartika Palar
- University of California, San Francisco, Department of Medicine, San Francisco, CA94143, USA
| | - Deshira D Wallace
- University of North Carolina at Chapel Hill, Department of Health Behavior, Chapel Hill, NC27599, USA
| | - Kathryn P Derose
- University of Massachusetts Amherst, Department of Health Promotion and Policy, Amherst, MA01003, USA
- RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA90401, USA
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Martinez-Brockman JL, Hromi-Fiedler A, Galusha D, Oladele C, Acosta L, Adams OP, Maharaj RG, Nazario CM, Nunez M, Nunez-Smith M, Pérez-Escamilla R. Risk factors for household food insecurity in the Eastern Caribbean Health Outcomes Research Network cohort study. Front Public Health 2023; 11:1269857. [PMID: 38074748 PMCID: PMC10702572 DOI: 10.3389/fpubh.2023.1269857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Background Globally, 1.3 billion people were considered food insecure as of 2022. In the Caribbean region, the prevalence of moderate or severe food insecurity was 71.3% as of 2020, the highest of all subregions in Latin America. Experienced based measurement scales, like the Latin American and Caribbean Food Security Scale, are efficient measurement tools of food insecurity used globally. The Eastern Caribbean Health Outcomes Research Network (ECHORN) Cohort Study is a population-based longitudinal cohort study in the two Caribbean U.S. territories of Puerto Rico and the U.S. Virgin Islands, as well as in Barbados and Trinidad & Tobago. The purpose of this research was to examine the demographic, psychosocial, behavioral, and environmental risk factors associated with household food insecurity (HFI) among adults ≥40 years of age in the ECHORN cohort. Methods A cross-sectional analysis of baseline ECHORN cohort study data was conducted. The primary outcome was household food insecurity (none, mild, moderate/severe). A total of 16 known and potential risk factors were examined for their association with HFI. The ANOVA and chi-square statistics were used in bivariate analysis. Ordinal logistic regression was used for the multivariable and sex stratified analyses. Results More than one-quarter of the sample (27.3%) experienced HFI. In bivariate analyses, all risk factors examined except for sex, were significantly associated with HFI status. In the multivariable analysis, all variables except sex, education, marital status, smoking status, and residing in Puerto Rico were significant predictors of HFI in the adjusted model. In sex stratified analysis, depression, food availability, self-rated physical health, and island site were significantly associated with increased odds of worsening HFI for women, but not for men. Source of potable water was an important risk factor for both men and women. Discussion The prevalence of HFI in the ECHORN cohort study is comparable to other studies conducted in the region. While women did not have an increased risk of HFI compared to men, a different set of risk factors affected their vulnerability to HFI. More research is needed to understand how water and food security are interrelated in the ECHORN cohort.
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Affiliation(s)
- Josefa L. Martinez-Brockman
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Amber Hromi-Fiedler
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Carol Oladele
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Lisbette Acosta
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
| | - O. Peter Adams
- Department of Family Medicine, Faculty of Medical Sciences, University of the West Indies, Cave Hill, Cave Hill, Barbados
| | - Rohan G. Maharaj
- Department of Paraclinical Sciences, University of the West Indies, Saint Augustine, Trinidad and Tobago
| | - Cruz M. Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico at Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- School of Nursing, University of the Virgin Islands, St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, New Haven, CT, United States
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, United States
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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Derose KP, Then-Paulino A, Han B, Armenta G, Palar K, Jimenez-Paulino G, Sheira LA, Acevedo R, Fulcar MA, Lugo Bernard C, Veloz Camacho I, Donastorg Y, Wagner GJ. Preliminary Effects of an Urban Gardens and Peer Nutritional Counseling Intervention on HIV Treatment Adherence and Detectable Viral Load Among People with HIV and Food Insecurity: Evidence from a Pilot Cluster Randomized Controlled Trial in the Dominican Republic. AIDS Behav 2023; 27:864-874. [PMID: 36066760 PMCID: PMC9446649 DOI: 10.1007/s10461-022-03821-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/01/2022]
Abstract
A pilot cluster randomized controlled trial involving two HIV clinics in the Dominican Republic assessed preliminary efficacy of an urban garden and peer nutritional counseling intervention. A total of 115 participants (52 intervention, 63 control) with moderate or severe food insecurity and sub-optimal antiretroviral therapy (ART) adherence and/or detectable viral load were assessed at baseline, 6- and 12-months. Longitudinal multivariate regression analysis controlling for socio-demographics and accounting for serial cluster correlation found that the intervention: reduced the prevalence of detectable viral load by 20 percentage points at 12 months; reduced any missed clinic appointments by 34 and 16 percentage points at 6 and 12 months; increased the probability of "perfect" ART adherence by 24 and 20 percentage points at 6 and 12 months; and decreased food insecurity at 6 and 12 months. Results are promising and warrant a larger controlled trial to establish intervention efficacy for improving HIV clinical outcomes.Trial registry Clinical Trials Identifier: NCT03568682.
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Affiliation(s)
- Kathryn P Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA.
- Department of Health Promotion and Policy, University of Massachusetts Amherst, 715 N. Pleasant St., Amherst, MA, 01003, USA.
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA, USA
- Division of Biostatistics Research, Department of Research & Evaluations, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Gabriela Armenta
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, CA, USA
| | - Kartika Palar
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila A Sheira
- Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - María A Fulcar
- World Food Programme, Country Office for the Dominican Republic, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz Camacho
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn J Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA, USA
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Rasul R, Rouzier V, Sufra R, Yan LD, Joseph I, Mourra N, Sabwa S, Deschamps MM, Fitzgerald DW, Pape JW, Nash D, McNairy ML. Extreme Food Insecurity and Malnutrition in Haiti: Findings from a Population-Based Cohort in Port-au-Prince, Haiti. Nutrients 2022; 14:4854. [PMID: 36432540 PMCID: PMC9695391 DOI: 10.3390/nu14224854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
Abstract
Haiti is one of the most food-insecure (FIS) nations in the world, with increasing rates of overweight and obesity. This study aimed to characterize FIS among households in urban Haiti and assess the relationship between FIS and body mass index (BMI) using enrollment data from the Haiti Cardiovascular Disease Cohort Study. FIS was characterized as no/low, moderate/high, and extreme based on the Household Food Security Scale. Multinomial logistic generalized estimating equations were used to evaluate the association between FIS categories and BMI, with obesity defined as BMI ≥ 30 kg/m2. Among 2972 participants, the prevalence of moderate/high FIS was 40.1% and extreme FIS was 43.7%. Those with extreme FIS had higher median age (41 vs. 38 years) and were less educated (secondary education: 11.6% vs. 20.3%) compared to those with no/low FIS. Although all FIS categories had high obesity prevalence, those with extreme FIS compared to no/low FIS (15.3% vs. 21.6%) had the lowest prevalence. Multivariable models showed an inverse relationship between FIS and obesity: moderate/high FIS (OR: 0.77, 95% CI: 0.56, 1.08) and extreme FIS (OR: 0.58, 95% CI: 0.42, 0.81) versus no/low FIS were associated with lower adjusted odds of obesity. We found high prevalence of extreme FIS in urban Haiti in a transitioning nutrition setting. The inverse relationship between extreme FIS and obesity needs to be further studied to reduce both FIS and obesity in this population.
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Affiliation(s)
- Rehana Rasul
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
- Institute of Implementation Science in Population Health, City University of New York, New York, NY 10027, USA
| | - Vanessa Rouzier
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Rodney Sufra
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Lily D. Yan
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Inddy Joseph
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Nour Mourra
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Shalom Sabwa
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Marie M. Deschamps
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Jean W. Pape
- Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, Port-au-Prince 6110, Haiti
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
| | - Denis Nash
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10017, USA
- Institute of Implementation Science in Population Health, City University of New York, New York, NY 10027, USA
| | - Margaret L. McNairy
- Center for Global Health, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
- Division of General Internal Medicine, Weill Cornell Medicine, 402 East 67th Street, New York, NY 10065, USA
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Derose KP, Han B, Armenta G, Palar K, Then-Paulino A, Jimenez-Paulino G, Sheira L, Acevedo R, Lugo C, Veloz I, Donastorg Y, Wagner G. Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic. AIDS Care 2022; 34:1234-1242. [PMID: 34581230 PMCID: PMC8958167 DOI: 10.1080/09540121.2021.1981218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 09/09/2021] [Indexed: 01/26/2023]
Abstract
Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.
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Affiliation(s)
- Kathryn P. Derose
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
- Department of Health Promotion and Policy, University of Massachusetts, Amherst
| | - Bing Han
- Economics, Sociology, & Statistics Department, RAND Corporation, Santa Monica, CA
| | | | - Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | - Gipsy Jimenez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Lila Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco, San Francisco, CA
| | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Claudio Lugo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Isidro Veloz
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Yeycy Donastorg
- Unidad de Vacunas e Investigación, Instituto Dermatológico Dominicano y Cirugía de Piel Dr. Huberto Bogaert Díaz, Santo Domingo, Dominican Republic
| | - Glenn Wagner
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, CA
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Oladele CR, Colón-Ramos U, Galusha D, Tran E, Adams OP, Maharaj RG, Nazario CM, Nunez M, Pérez-Escamilla R, Nunez-Smith M. Perceptions of the local food environment and fruit and vegetable intake in the Eastern Caribbean Health Outcomes research Network (ECHORN) Cohort study. Prev Med Rep 2022; 26:101694. [PMID: 35242499 PMCID: PMC8861285 DOI: 10.1016/j.pmedr.2022.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 12/26/2021] [Accepted: 01/15/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Studies conducted in the US and other high-income countries show that the local food environment influences dietary intakes that are protective for cardiovascular health.However, few studies have examined this relationship in the Caribbean. This study aimed to determine whether perceptions of the local food environment were associated with fruit and vegetable (FV) intake in the Eastern Caribbean, where daily FV intake remains below recommended levels. METHODS Cross-sectional analysis of Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) baseline data (2013-2016) from Barbados, Puerto Rico, Trinidad and Tobago, and US Virgin Islands was conducted in 2020. The National Cancer Institute Dietary Screener Questionnaire was adapted to measure daily servings of FV. Existing scales were used to assess participant perceptions of the food environment (availability, affordability, and quality). Chi-square tests and Poisson regression were used for analyses. RESULTS Participants reported eating one mean daily serving of FV. Mean daily intake was higher among those who perceived FV as usually/always affordable, available, and high quality. Multivariate results showed statistically significant associations between FV and affordability. Persons who perceived FV as affordable had 0.10 more daily servings of FV compared to those who reported FV as not always affordable (p = 0.02). Food insecurity modified the association between affordability and FV intake. CONCLUSIONS This study highlights the importance of affordability in consumption of FV in the Eastern Caribbean, and how this relationship may be modified by food insecurity.
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Affiliation(s)
- Carol R Oladele
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
| | - Uriyoán Colón-Ramos
- Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW #2, Washington, DC 20052, USA
| | - Deron Galusha
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
| | - Emma Tran
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
| | - Oswald P Adams
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Rohan G Maharaj
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Trinidad and Tobago
| | - Cruz M Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Maxine Nunez
- University of the Virgin Islands, School of Nursing, St. Thomas, US VI, USA
| | - Rafael Pérez-Escamilla
- Department of Social and Behavioral Sciences, Yale School of Public Health, 135 College Street, Suite 216, New Haven, CT 06520, USA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale School of Medicine, 100 Church Street South, Suite A200, New Haven, CT 06510, USA
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Coelho LE, Jenkins CA, Shepherd BE, Pape JW, Cordero FM, Padgett D, Ramirez BC, Grinsztejn B, Althoff KN, Koethe JR, Marconi VC, Tien PC, Willig AL, Moore RD, Castilho JL, Colasanti J, Crane HM, Gill MJ, Horberg MA, Mayor A, Silverberg MJ, McGowan C, Rebeiro PF. Weight gain post-ART in HIV+ Latinos/as differs in the USA, Haiti, and Latin America. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100173. [PMID: 35528706 PMCID: PMC9070999 DOI: 10.1016/j.lana.2021.100173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background An obesity epidemic has been documented among adult Latinos/as in Latin America and the United States (US); however, little is known about obesity among Latinos/as with HIV (PWH). Moreover, Latinos/as PWH in the US may have different weight trajectories than those in Latin America due to the cultural and environmental contexts. We assessed weight and body mass index (BMI) trajectories among PWH initiating antiretroviral therapy (ART) across 5 countries in Latin America and the Caribbean and the US. Methods ART-naÿve PWH ≥18 years old, enrolled in Brazil, Honduras, Mexico, Peru, and Haiti (sites within CCA-SAnet) and the US (NA-ACCORD) starting ART between 2000 and 2017, with at least one weight measured after ART initiation were included. Participants were classified according to site/ethnicity as: Latinos/as in US, non-Latinos/as in US, Haitians, and Latinos/as in Latin America. Generalized least squares models were used to assess trends in weight and BMI. Models estimating probabilities of becoming overweight/obese (BMI ≥25 kg/m2) and of becoming obese (BMI ≥30 kg/m2) post ART initiation for males and females were fit using generalized estimating equations with a logit link and an independence working correlation structure. Findings Among 59,207 PWH, 9% were Latinos/as from Latin America, 9% Latinos/as from the US, 68% non-Latinos/as from the US and 14% were Haitian. At ART initiation, 29% were overweight and 14% were obese. Post-ART weight and BMI increases were steeper for Latinos/as in Latin America compared with other sites/ethnicities; however, BMI at 3-years post ART remained lower compared to Latinos/as and non-Latinos/as in the US. Among females, at 3-years post ART initiation the greatest adjusted probability of obesity was found among non-Latinas in the US (15·2%) and lowest among Latinas in Latin America (8.6%). Among males, while starting with a lower BMI, Latinos in Latin America had the greatest adjusted probability of becoming overweight or obese 3-years post-ART initiation. Interpretation In the Americas, PWH gain substantial weight after ART initiation. Despite environmental and cultural differences, PWH in Latin America, Haiti and Latinos and non-Latinos in the US share similar BMI trajectories on ART and high probabilities of becoming overweight and obese over time. Multicohort studies are needed to better understand the burden of other metabolic syndrome components in PWH across different countries.
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Affiliation(s)
- Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jean W. Pape
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
| | - Fernando Mejia Cordero
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Denis Padgett
- Instituto Hondureño de Seguridad Social & Hospital Escuela Universitario, Tegucigalpa, Honduras
| | - Brenda Crabtree Ramirez
- Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - John R. Koethe
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | - Phyllis C. Tien
- Department of Medicine, University of California, San Francisco (UCSF), and the Department of Veterans Affairs Medical Center. San Francisco, CA, USA
| | - Amanda L. Willig
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Jessica L. Castilho
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Colasanti
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
| | | | | | - Michael A. Horberg
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD, US
| | - Angel Mayor
- Universidad Central del Caribe, Retrovirus Research Center, Bayamón, PR, US
| | | | - Catherine McGowan
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter F. Rebeiro
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - North American AIDS Collaboration on Research and Design (NA-ACCORD) and the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) of the International epidemiology Databases to Evaluate AIDS (IeDEA)
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Groupe Haitien d'Etudes du Sarcome de Kaposi et des Infections Opportunistes, Port-au-Prince, Haiti
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto Hondureño de Seguridad Social & Hospital Escuela Universitario, Tegucigalpa, Honduras
- Deparatmento de Infectologia, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. Mexico City, Mexico
- Johns Hopkins University, Baltimore, MD, USA
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, USA
- Department of Medicine, University of California, San Francisco (UCSF), and the Department of Veterans Affairs Medical Center. San Francisco, CA, USA
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- University of Washington, Seattle, WA, US
- The University of Calgary, Calgary, AB, Canada
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, MD, US
- Universidad Central del Caribe, Retrovirus Research Center, Bayamón, PR, US
- Kaiser Permanente Northern California, Oakland, CA, US
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9
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Wallace DD, Payán DD, Then-Paulino A, Armenta G, Fulcar MA, Acevedo R, Derose KP. Perceptions and determinants of healthy eating for people with HIV in the Dominican Republic who experience food insecurity. Public Health Nutr 2021; 24:3018-3027. [PMID: 32830629 PMCID: PMC7902734 DOI: 10.1017/s1368980020002694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The current study aimed to understand how moderate and severe food-insecure people living with HIV (PLHIV) in the Dominican Republic perceive a healthy diet and explore facilitators and barriers to engaging in healthy dietary behaviours as a means of HIV self-management. DESIGN We conducted semi-structured interviews with PLHIV. We generated codes on food insecurity among PLHIV and used content analysis to organise codes for constant comparison between and within participants. SETTING Two urban HIV clinics in the Dominican Republic. PARTICIPANTS Thirty-two PLHIV participated in the interviews. RESULTS Factors that contributed to dietary behaviours include individual factors, such as knowledge of nutrition, views and attitudes on healthy dietary behaviours, beliefs about dietary needs for PLHIV and diet functionality. Interpersonal factors, including assistance from family and peers in providing food or funds, were deemed critical along with community and organisational factors, such as food assistance from HIV clinics, accessibility to a variety of food store types and the availability of diverse food options at food stores. Policy-level factors that influenced dietary behaviours were contingent on respondents' participation in the labour market (i.e. whether they were employed) and consistent access to government assistance. Food insecurity influenced these factors through unpredictability and a lack of control. CONCLUSIONS PLHIV who experience food insecurity face various barriers to engaging in healthy dietary behaviours. Their diets are influenced at multiple levels of influence ranging from individual to structural, requiring multi-level interventions that can address these factors concurrently.
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Affiliation(s)
- Deshira D Wallace
- RAND Corporation, 1776 Main Street, Santa Monica, 90407CA, USA
- Gillings School of Global Public Health, University of North Carolina, 302 Rosenau Hall, Chapel Hill, 27599NC, USA
| | - Denise D Payán
- University of California at Merced, Merced, 95343CA, USA
| | | | | | - María Altagracia Fulcar
- Dominican Republic Country Office, United Nations World Food Programme, Santo Domingo, Dominican Republic
| | - Ramón Acevedo
- CONAVIHSIDA – Consejo Nacional de VIH/SIDA, Santo Domingo, Dominican Republic
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10
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Derose KP, Fulcar MA, Acevedo R, Armenta G, Jiménez-Paulino G, Bernard CL, del Rosario LEP, Then-Paulino A. An Integrated Urban Gardens and Peer Nutritional Counseling Intervention to Address Food Insecurity Among People With HIV in the Dominican Republic. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:187-201. [PMID: 34014110 PMCID: PMC8274817 DOI: 10.1521/aeap.2021.33.3.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Food insecurity negatively affects HIV prevention and care, and sustainable interventions are needed. Here we describe the development of an integrated urban gardens and peer nutritional counseling intervention to address food insecurity and nutrition among people with HIV, which included: (1) peer nutritional counseling, (2) gardening training, and (3) garden-based nutrition and cooking workshops. The intervention was developed using community-based participatory research over multiple years and stages of data gathering and implementation and evaluation. Lessons learned include the importance of cross-sectoral partnerships to achieve multifaceted, integrated, and sustainable interventions and a shared commitment among partners to an ongoing cycle of action-oriented research, and the need for home-based and community-based gardens to enhance food security and social support. The development process successfully combined an evidence-based framework and community engagement to yield a multicomponent yet integrated food security and nutrition intervention appropriate for people with HIV and potentially adaptable for other chronic conditions.
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Affiliation(s)
- Kathryn P. Derose
- RAND Corporation, Santa Monica, CA, USA
- University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Ramón Acevedo
- Consejo Nacional para el VIH y Sida (CONAVIHSIDA), Santo Domingo, Dominican Republic
| | - Gabriela Armenta
- RAND Corporation, Santa Monica, CA, USA
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | - Gipsy Jiménez-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | - Claudio Lugo Bernard
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
| | | | - Amarilis Then-Paulino
- Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic
- Ministerio de Salud Pública, Santo Domingo, Dominican Republic
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11
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Costa CRB, Melo ES, Antonini M, Pontes PS, Gir E, Reis RK. Overweight and obesity in people living with HIV. Rev Gaucha Enferm 2021. [DOI: 10.1590/1983-1447.2021.20200310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective To identify overweight and obesity and as associated variables in people living with HIV. Method Cross-sectional, quantitative and analytical study, developed in specialized services in southeastern Brazil. Individual specifics were carried out from 2014 to 2016. Pearson's Chi-Square test, Logistic Regression and OddsRatio (OR) were used. Results Of the 340 respondents, 47.7% were overweight. The highest abdominal circumferences and lipid changes were predominantly among the highest body mass index (BMI). The greatest chances of obtaining BMI values>25 kg/m² were among men (OR: 1.87; 95% CI: 1.02-2.42), having metabolic syndrome (OR: 5.66; 95% CI: 3.26-9.83) and the undue (OR: 3.89; 95% CI: 2.17-7.00). However, having self-reported hypertension was configured as a protective factor (OR: 0.18; 95% CI: 0.08-0.44). Conclusion The frequency of obesity and overweight between PLHIV was high. There was an association of male gender, metabolic syndrome and smoking with weight gain. The presence of self-reported hypertension was considered a protective factor.
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12
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Derose KP, Palar K, Farías H, Adams J, Martínez H. Developing Pilot Interventions to Address Food Insecurity and Nutritional Needs of People Living With HIV in Latin America and the Caribbean: An Interinstitutional Approach Using Formative Research. Food Nutr Bull 2018; 39:549-563. [PMID: 30453759 DOI: 10.1177/0379572118809302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Food insecurity and malnutrition present challenges to HIV management, but little research has been done in Latin America and the Caribbean (LAC). OBJECTIVE To assess levels of food insecurity and malnutrition among people living with HIV (PLHIV) across multiple countries in LAC to inform pilot projects and policy. METHODS Through interinstitutional collaboration, we collected data on sociodemographics, household food security, anthropometry, and commonly consumed foods among adults seeking care at HIV clinics in Bolivia, Honduras, and the Dominican Republic (DR; N = 400) and used the results for pilot projects. RESULTS Most PLHIV had moderate or severe household food insecurity (61% in Bolivia, 71% in Honduras, and 68% in DR). Overweight and obesity were also highly prevalent, particularly among women (41%-53% had body mass index ≥25). High body fat was also prevalent, ranging from 36% to 59%. Among salient foods, fruits and vegetables were lacking. Country-specific pilot projects incorporated locally tailored nutrition counseling with a monthly household food ration, linkage to income-generating projects, or urban gardens. Nutritional counseling was conducted initially by professionals and later modified for peer counselors given the lack of nutritionists. CONCLUSION High levels of food insecurity and overweight among PLHIV in LAC have important implications, since prior interventions to address food insecurity among PLHIV have focused on underweight and wasting. Formative research and intersectoral collaboration facilitated locally appropriate nutritional materials and interventions, enhanced local capacities, and helped incorporate nutritional guidelines into policies and practice. Addressing human capital constraints in resource-poor settings and developing complementary strategies were key recommendations.
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Affiliation(s)
| | - Kartika Palar
- 2 Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Hugo Farías
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Jayne Adams
- 3 United Nations World Food Programme, Regional Bureau for Latin America and the Caribbean, Panama City, Panama
| | - Homero Martínez
- 1 RAND Corporation, Santa Monica, CA, USA.,4 Hospital Infantil de México Federico Gómez, Mexico City, Mexico.,5 Nutrition International, Ottawa, Canada
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