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Sridhar S, Kang J, Makasa J, Bell-Cross S, Madzorera I, Zulu E, Hamer DH. Impact of COVID-19 on food security and diet quality in Chilanga District, Zambia. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:27. [PMID: 38360811 PMCID: PMC10868044 DOI: 10.1186/s41043-024-00523-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Food security and nutrition have been severely impacted during the COVID-19 pandemic, particularly in low- and middle-income countries (LMICs). We aimed to quantify the impacts of the pandemic on food security and diet diversity within Chilanga District in Zambia and identify target areas for high-impact social protection and safety net programs. METHODS We conducted a cross-sectional study in Chilanga district immediately after the Omicron variant surge in February 2022. Diet quality and food security were assessed based on a household diet questionnaire and a Minimum Dietary Diversity-Women (MDD-W) score was calculated. A paired t-test was used to determine whether there was a statistically significant change in the MDD-W score and McNemar test was used to investigate the change in food security between the pre- and peri-COVID-19 period. RESULTS Compared to the pre-COVID-19 period, there were increases in food prices across the board in the peri-COVID-19 period and decreased consumption of key food categories including legumes, dairy and vitamin A rich foods. Despite high rates of food insecurity, only 6.6% of surveyed households received any cash or in-kind assistance from a government agency, non-profit, or other organization in the post-COVID-19 period. CONCLUSION The COVID-19 pandemic had significant impacts on food security and dietary diversity in Chilanga district. This is particularly relevant in the low-income communities that we surveyed, which had pre-existing challenges with food security. Additional resources must be invested in Chilanga District and similarly affected areas to address this gap in access to food and promote national equity. Trial Registration N/A.
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Affiliation(s)
- Shela Sridhar
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
| | - Janella Kang
- Department of Child, Youth, and Family Studies, University of Nebraska - Lincoln, Lincoln, NE, USA
| | | | | | - Isabel Madzorera
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Palar K, Sheira LA, Frongillo EA, Kushel M, Wilson TE, Conroy AA, Adedimeji A, Merenstein D, Cohen MH, Wentz EL, Adimora AA, Ofotokun I, Metsch LR, Turan JM, Tien PC, Weiser SD. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV. AIDS Behav 2023; 27:3345-3355. [PMID: 37067613 PMCID: PMC10783960 DOI: 10.1007/s10461-023-04053-9] [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] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.
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Affiliation(s)
- Kartika Palar
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Lila A Sheira
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Margot Kushel
- Division of General Internal Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA
| | - Tracey E Wilson
- Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA
| | - Amy A Conroy
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Merenstein
- Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Mardge H Cohen
- Department of Medicine, Stroger Hospital, Chicago, IL, USA
| | - Eryka L Wentz
- Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Adaora A Adimora
- School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ighovwerha Ofotokun
- School of Medicine, Emory University, Atlanta, GA, USA
- Grady Healthcare System, Atlanta, GA, USA
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phyllis C Tien
- Department of Medicine, University of California, San Francisco, CA, USA
- Medical Service, Department of Veteran Affairs Medical Center, San Francisco, USA
| | - Sheri D Weiser
- Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA
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Wilson EC, Hernandez CJ, Scheer S, Trujillo D, Arayasirikul S, Sicro S, McFarland W. Improved PrEP Awareness and Use among Trans Women in San Francisco, California. AIDS Behav 2022; 26:596-603. [PMID: 34390435 PMCID: PMC8813678 DOI: 10.1007/s10461-021-03417-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 11/25/2022]
Abstract
Transgender women face a serious risk of HIV infection. Despite this, there is limited knowledge and use of Pre-exposure prophylaxis (PrEP). We measured the continuity of prevention across services in the PrEP cascade and correlates of PrEP use among trans women in San Francisco enrolled in the 2019/20 National HIV Behavioral Surveillance Study. Knowledge and use of PrEP among trans women in San Francisco increased in recent years; almost all (94.0%) had heard about PrEP, 64.7% had discussed PrEP with a healthcare provider, and 44.8% had taken PrEP in the past 12 months. PrEP use was associated with participation in a PrEP demonstration project (aOR = 31.44, p = 0.001) and condomless receptive anal intercourse (aOR = 3.63, p = 0.024). Injection drug use was negatively associated (aOR = 0.19, p = 0.014). Efforts are needed to combat the gender-based stigma and discrimination faced by trans women, which can result in avoidance and mistrust of the medical system.
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Affiliation(s)
- Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA.
| | - Christopher J Hernandez
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Susan Scheer
- HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Dillon Trujillo
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Sofia Sicro
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness Avenue, San Francisco, CA, 94102, USA
- Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA, USA
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Mugglin C, Kläger D, Gueler A, Vanobberghen F, Rice B, Egger M. The HIV care cascade in sub-Saharan Africa: systematic review of published criteria and definitions. J Int AIDS Soc 2021; 24:e25761. [PMID: 34292649 PMCID: PMC8297382 DOI: 10.1002/jia2.25761] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The HIV care cascade examines the attrition of people living with HIV from diagnosis to the use of antiretroviral therapy (ART) and suppression of viral replication. We reviewed the literature from sub-Saharan Africa to assess the definitions used for the different steps in the HIV care cascade. METHODS We searched PubMed, Embase and CINAHL for articles published from January 2004 to December 2020. Longitudinal and cross-sectional studies were included if they reported on at least one step of the UNAIDS 90-90-90 cascade or two steps of an extended 7-step cascade. A step was clearly defined if authors reported definitions for numerator and denominator, including the description of the eligible population and methods of assessment or measurement. The review protocol has been published and registered in Prospero. RESULTS AND DISCUSSION Overall, 3364 articles were screened, and 82 studies from 19 countries met the inclusion criteria. Most studies were from Southern (38 studies, 34 from South Africa) and East Africa (29 studies). Fifty-eight studies (71.6%) were longitudinal, with a median follow-up of three years. The medium number of steps covered out of 7 steps was 3 (interquartile range [IQR] 2 to 4); the median year of publication was 2015 (IQR 2013 to 2019). The number of different definitions for the numerators ranged from four definitions (for step "People living with HIV") to 21 (step "Viral suppression"). For the denominators, it ranged from three definitions ("Diagnosed and aware of HIV status") to 14 ("Viral suppression"). Only 12 studies assessed all three of the 90-90-90 steps. Most studies used longitudinal data, but denominator-denominator or denominator-numerator linkages over several steps were rare. Also, cascade data are lacking for many countries. Our review covers the academic literature but did not consider other data, such as government reports on the HIV care cascade. Also, it did not examine disengagement and reengagement in care. CONCLUSIONS The proportions of patients retained at each step of the HIV care cascade cannot be compared between studies, countries and time periods, nor meta-analysed, due to the many different definitions used for numerators and denominators. There is a need for standardization of methods and definitions.
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Affiliation(s)
- Catrina Mugglin
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Delia Kläger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Aysel Gueler
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Fiona Vanobberghen
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
- Swiss Tropical and Public Health InstituteBaselSwitzerland
- University of BaselBaselSwitzerland
| | - Brian Rice
- Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER)University of Cape TownCape TownSouth Africa
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
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