Food access and diet quality are associated with quality of life outcomes among HIV-infected individuals in Uganda

Associated factors of diet quality among people living with HIV/AIDS in Ghana

INTRODUCTION

Nutrition is a very important element of a comprehensive care for people living with HIV/AIDS (PLHIV), especially in resource-constrained settings where malnutrition and food insecurity are common. Dietary diversity is a useful indication of nutritional adequacy (diet quality) in people of all ages. An optimally diverse diet strengthens the body's immune system.

OBJECTIVE

This study aimed to assess diet quality and its associated factors among PLHIV.

METHODS

A facility-based cross-sectional study design was employed to select 440 PLHIV from two hospitals in the Eastern Region of Ghana. Dietary intakes were determined using 24-hour recall. A stadiometer and bioimpedance analysis machine were used to obtain anthropometric and body composition data. Diet quality was assessed using FAO's individual dietary diversity score (IDDS) as a proxy. SPSS version 20 was used for analysis. Odds ratios and ordinal logistic regression were used to identify factors associated with diet quality among the PLHIV. P-value was set at 0.05.

RESULTS

Most of the PLHIV (73%) consumed from 'Starchy staple" food group. Less than 20% of the study sample consumed 'Fruits' and 'Vegetables' (17% and 14% respectively) a day before the survey. The mean IDDS was 4.11 (SD = 1.29). Overall, most of the PLHIV (56%) had medium IDDS which is equivalent to "diet needing improvement', 14% had higher IDDS (good diet), whiles about 31% of the participants actually had poor diet (lower IDDS). Associated factors of diet quality were age (AOR = 0.966: 95%CI: 0.936-0.997: p = 0.031), married (AOR = 4.634: 95%CI: 1.329-16.157: p = 0.0016), separated (AOR = 0.0203: 95%CI: .036-0.994: p = 0.049), and daily meal frequency (AOR = 0.441: 95%CI: .478-1.948: p = 0.020). Overall, the model accounts for about 20% of the variation in diet quality of the participants (pseudo-R square = 0.196).

CONCLUSION

This study demonstrates that most of the PLHIV did not consume good diet which may have an implication on their immune system, which is already under attack by HIV, and probably emerging infections. Age, marital status, and meal frequency were the variables that predicted diet quality among the study participants.

Prevalence and factors associated with the Minimum Dietary Diversity among HIV-positive women receiving Antiretroviral Therapy in Kabale district, Uganda

BACKGROUND

Malnutrition and HIV form a vicious cycle and women are at an increased risk of malnutrition from HIV. The Food and Agriculture Organization (FAO) recommends a minimum dietary diversity for women (MDD-W) of five food groups; however, paucity of information exists about the diet quality of this population in Uganda. The present study aimed to determine the prevalence and factors associated with the MDD among HIV positive women of reproductive age (15-49 years) receiving antiretroviral therapy in Kabale district, Uganda.

METHODS

This was a cross-sectional study. Probability proportional to size sampling was applied to select the number of participants per clinic and respondents were sampled systematically on a particular day in each clinic. A structured questionnaire was used to collect data on the respondent characteristics and the FAO's Individual Dietary Diversity questionnaire was used to collect the 24-hour dietary intake. Data were analysed using appropriate software. Descriptive statistics were applied for univariate analysis. Modified Poisson was used to determine the factors associated with MDD. The study was approved by the Makerere University School of Public Health Institutional Review Board and informed consent was obtained from the respondents.

RESULTS

Some 90.9% of the respondents were Bakiga, mean age was 34.8 ± 8.1 years, 47.6% were married and 98.0% came from nuclear families with 4.4 ± 1.9 members. The mean number of food groups consumed was 4.7 ± 1.7 with roots and tubers, pulses, and dark leafy and vitamin A vegetables, whereas milk and eggs were mostly consumed and fruits were least consumed. The prevalence of the MDD-W was 48.2%. Factors associated with MDD score at multivariate level included; age, type of employment, having nausea, viral load status and HIV clinical stage.

CONCLUSIONS

Almost one half of the HIV positive women on antiretroviral therapy in the district achieve the MDD-W, attributed to being middle aged, being casual employment and having an unsuppressed viral load.

Psychosocial predictors of quality of life among women living with HIV/AIDS: a cross-sectional study in a VCT centre in Shiraz, Iran

PURPOSE

We aimed to assess psychosocial predictors of quality of life (QOL) among women living with HIV/AIDS (WLHIV). QOL has been considered as an important indicator in evaluating the outcome of psychological and physical healthcare in people living with HIV (PLHIV).

METHODS

This cross-sectional study was carried out from October 2021 to April 2022 at the Voluntary, Counselling, and Testing (VCT) center in Shiraz, Iran. A total of 452 WLHIV were included in this study. Socio-demographic and clinical data, social support (MSPSS questionnaire), food insecurity (HFIAS questionnaire), resilience (CD-RISC questionnaire), mental health status (DASS questionnaire), and QOL (WHOQOL-BREF questionnaire) were collected through direct interviews and patients' files at Shiraz VCT.

RESULTS

Physical and social relationships domains of QOL had the highest (60.48 ± 18.00) and lowest (36.76 ± 23.88) scores, respectively. Higher clinical stage, psychotropic substances use, having a husband infected with HIV, history of hypertension, and higher socioeconomic status had a significant relationship with some domains of QOL. The score of social support, food insecurity, resilience, and mental health status had a significant relationship with all domains of QOL.

CONCLUSION

Social relationships domain of QOL had the lowest scores in WLHIV. Also, the mental health status of WLHIV was more related to their QOL than the physical status related to HIV/AIDS. Interventions such as improving the mental health care and resilience skills of WLHIV, including their social network in counseling services to promote their social support, could help them to improve their QOL.

Quality of life among people living with HIV aged 50 years and over in Australia: Identifying opportunities to support better ageing

OBJECTIVES

Improved life expectancy has led to an ageing population of people living with HIV in most countries. Research on ageing among people living with HIV has predominantly focused on physical and health-related quality of life rather than multidimensional quality of life. We measured quality of life among older people living with HIV in Australia and identified opportunities to guide the development and implementation of appropriate interventions.

METHODS

In a national health and wellbeing survey of Australian people living with HIV, participants aged ≥50 years completed additional questions relevant to ageing. Quality of life was measured using PozQoL, a validated multidimensional instrument assessing quality of life among people living with HIV (range 1-5). Exploratory bivariate analyses aimed to identify sociodemographic characteristics associated with quality of life. Adjusted linear regressions aimed to assess changes in PozQoL score associated with recent experiences (last 12 months) of four exposures: food insecurity, HIV-related stigma, isolation from the HIV community, and difficulties accessing non-HIV health services.

RESULTS

Among 319 older people living with HIV, the mean PozQol score was 3.30 (95% confidence interval [CI] 3.20-3.39). In bivariate analyses, PozQol scores were significantly higher among participants who were older (p = 0.006), had higher educational attainment (p = 0.009), were in a relationship (p = 0.005), were employed (p = 0.005), and had a higher income (p = 0.001). In adjusted regression models, PozQoL scores were lower among participants who reported recent experiences of food insecurity (β -0.49; 95% CI -0.74 to -0.24), stigma (β -0.53; 95% CI -0.73 to -0.33), isolation from the HIV community (β -0.49; 95% CI -0.70 to -0.29), and difficulties accessing non-HIV health services (β -0.50; 95% CI -0.71 to -0.30).

CONCLUSIONS

Overall, older people living with HIV in this study had a moderate quality of life. Our findings suggest that HIV services should integrate programmes to support economic security and foster connections within the HIV community and across health services.

Determinants of health-related quality of life in people with Human Immunodeficiency Virus, failing first-line treatment in Africa

BACKGROUND

Antiretroviral treatment improves health related quality of life (HRQoL) of people with human immunodeficiency virus (PWH). However, one third initiating first-line treatment experience virological failure and the determinants of HRQoL in this key population are unknown. Our study aims to identify determinants of among PWH failing antiretroviral treatment in sub-Saharan Africa.

METHODS

We analysed data from a cohort of PWH having virological failure (> 1,000 copies/mL) on first-line ART in South Africa and Uganda. We measured HRQoL using the EuroQOL EQ-5D-3L and used a two-part regression model to obtain by-country analyses for South Africa and Uganda. The first part identifies risk factors that were associated with the likelihood of participants reporting perfect health (utility = 1) versus non-perfect health (utility < 1). The second part identifies risk factors that were associated with the EQ-5 L-3L utility scores for participants reporting non-perfect health. We performed sensitivity analyses to compare the results between the two-part model using tobit models and ordinary least squares regression.

RESULTS

In both countries, males were more likely to report perfect health and participants with at least one comorbidity were less likely to report perfect health. In South Africa, participants with side effects and in Uganda those with opportunistic infections were also less likely to report perfect health. In Uganda, participants with 100% ART adherence were more likely to report perfect health. In South Africa, high HIV viral load, experiencing ART side effects, and the presence of opportunistic infections were each associated with lower HRQoL, whereas participants with 100% ART adherence reported higher HRQoL. In Uganda participants with lower CD4 count had lower HRQoL.

CONCLUSION

Markers of advanced disease (opportunistic infection, high viral load, low CD4), side effects, comorbidities and lack of ART adherence negatively impacted HRQoL for PWH experiencing virological failure.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT02787499.

Food insecurity and associated factors among adult HIV patients on anti-retroviral therapy in Dessie referral hospital, South Wollo Zone, North central Ethiopia

Food insecurity has a paramount negative impact on the overall nutritional and health status of people living with the human immune deficiency virus, hence leading to opportunistic infections, rapid disease progression, hospitalizations, poor treatment outcomes, and mortality, both are intertwined and worsen one another through a mixture of nutritional, mental health, and behavioral pathways that heighten vulnerability to, and worsen the severity of, each condition. Nevertheless, little is known about the magnitude of food insecurity and associated factors among adults on antiretroviral therapy in the current study area. This study aims to assess the magnitude of food insecurity and associated factors among Adults on Antiretroviral Treatment in Dessie referral hospital South Wollo Zone, Northcentral Ethiopia. An institution-based cross-sectional study was conducted among 407 selected adults living with Human Immune Virus receiving Anti-Retroviral treatment in Dessie referral hospital. Data was entered into Epi-data version 3.1 and exported to STATA version 16.0 for cleaning and analysis. Bivariable and multivariable binary logistic regression analysis was carried out to identify factors associated with the outcome variable. Odds ratio along with 95% confidence interval was estimated to measure the strength of the association and the level of statistical significance was declared at a p-value less than 0.05. This study revealed that the magnitude of food insecurity was 62.4% (95% CI: 57.6, 44 66.8]. CD4 count <350 [AOR = 3.51, 95% CI: 1.88, 6.52], average monthly household income ≤ 40 USD [AOR = 2.34, 95% CI: 1.42, 3.84], World Health Organization clinical stage III&IV [AOR = 2.85, 95% CI: 1.61, 5.04], not getting any support [AOR = 3.04, 95% CI: 1.45, 6.38] were factors significantly associated with food insecurity. Social protection interventions targeting patients with CD4 <350, monthly income less than 40 USD/month, World Health Organization clinical stage III &IV, and those patients with no support are crucial interventions for food security.

Diet quality, food insecurity and risk of cardiovascular diseases among adults living with HIV/AIDS: a scoping review protocol

INTRODUCTION

Cardiovascular diseases (CVDs) are the single greatest contributor to global mortality. The successful introduction and scale-up of antiretroviral therapy (ART) delivered a reduction in HIV mortality. Consequently, an association was found between the scale-up of ART and an increased prevalence of comorbidities among people living with HIV (PLWH) such as hypertension and dyslipidaemia. A higher quality diet can delay the onset of comorbidities related to HIV infection. Diet quality and its methods of assessment are not fully established among PLWH. This review will identify the diet quality and food insecurity indices that have been used among PLWH and how these constructs are associated with risk of developing CVD.

METHODS AND ANALYSIS

The frameworks recommended by Arksey and O'Malley and the Joanna Briggs Institute's manual for conducting scoping reviews will be adopted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines will be used for reporting. A search strategy was developed using keywords related to the topic. A preliminary MEDLINE (via PubMed) search was conducted on 11 November 2020 to develop a comprehensive search strategy. The final search will be conducted on PubMed, EbscoHost, Scopus, Web of Science and Cochrane Library databases. Titles and abstracts of retrieved records will be screened independently by two reviewers. Data will be extracted from records that meet the inclusion criteria using a predesigned charting tool. Discrepancies in decisions made by reviewers will be resolved by consensus or the decision of a third reviewer. Extracted data will be presented in tables or charts. A descriptive summary of the charts or tables will follow.

ETHICS AND DISSEMINATION

Ethical approval is not required for a scoping review. Findings will inform other studies currently underway and will be presented at conferences and published in peer-reviewed journals. REGISTRATION NUMBER: https://osf.io/7k3ja.

Differences in quality of life and food insecurity between men and women living with HIV/AIDS in the state of Paraíba, Brazil

A prevalence study was conducted to compare quality of life and food insecurity in men and women living with HIV/AIDS. The sample comprised 481 HIV-infected individuals undergoing antiretroviral therapy at a referral hospital in the State of Paraíba, Brazil. Food insecurity and quality of life were assessed using the Brazilian Household Food Insecurity Scale and WHOQOL-HIV Bref, respectively. The results were presented as absolute and relative frequencies and gender differences were tested using the chi-squared test adopting a significance level of 0.05. The findings showed that 40.1% of the sample were women. A higher percentage of women than men had a low income and low education level (65.8% and 72.5%, respectively). Prevalence of food security was lower in women than in men (29.0% compared to 42.7%), and a higher percentage of women than men reported below average quality of life (54.9% compared to 44.4%). The findings reveal that, besides the usual difficulties faced by HIV-infected patients, this group showed a significant level of gender inequality. The management of HIV patient care should consider these important findings, promoting access to care and support services and gender equality so that women can live fairer and more equal lives.

The impact of food insecurity on mental health in Africa: A systematic review

In 2018, 676.1 million people in Africa (52.5% of the population) were moderately or severely food insecure. This exceptionally high prevalence continues to increase as Africa experiences conflict, climate change, and economic declines. When Sustainable Development Goal 2.1 set out to end hunger and ensure access to sufficient food, particularly for vulnerable populations, by 2030, food insecurity emerged as a global priority. Food insecurity has been hypothesized to negatively impact mental health, a stigmatized area of health in Africa for which care is often inaccessible. This systematic review examines existing literature on the relationship between food insecurity and mental health in Africa, where progress remains to be made on both fronts. A systematic search of seven databases (EMBASE, Web of Science, CINAHL, PsychINFO ProQuest, Medline Ovid, Scopus, and Nursing and Allied Health) was conducted. Results were limited to studies examining food insecurity and mental health, written in English and published between January 2000 and May 2020. After title, abstract, full-text review, and quality appraisal using tools from the National Heart, Lung, and Blood Institute, 64 studies remained. Findings were summarized using a narrative synthesis approach. Studies unanimously highlighted that food insecurity is associated with poor mental health. This relationship was dose-responsive and independent of the measured mental health outcome. Two highly represented groups in the literature were women around pregnancy and people affected by HIV/AIDS. Factors which mediated the relationship included age, sex, social interactions, physical health, seasonality, and rural residence. The findings suggest that the relationship is likely amplified in specific populations such as women and seniors, and interventions which target livelihood as opposed to income may be more effective. Further research is needed which compares food insecurity's effect on mental health between at-risk populations, in order to guide resource allocation and context-specific policy making.

Health-related quality of life of people living with HIV/AIDS: the role of social inequalities and disease-related factors

Background

Health-related quality of life (HRQoL) serves as a direct measure of individuals’ health, life expectancy and the impact that the utilization of health care has on quality of life. The purpose of this study is to assess the HRQoL of people living with HIV (PLHIV), and to ascertain its association with the social inequalities and clinical determinants among people living with HIV in Benishangul Gumuz Regional State, Ethiopia.

Methods

A cross-sectional study was conducted between December 2016 and February 2017; 390 people at two referral hospitals and three health centers participated in the study. The Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS Global 10) was used to measure key HRQoL domains. Global Physical Health (GPH) and Global Mental Health (GPH) summary scores were employed. GPH and GMH summary scores below 50 (the standardized mean score) were determined as poor HRQoL. Bivariate and multivariate logistic regression analyses were used to identify factors associated with GPH and GMH summary scores.

Results

This study included 259 (66.4%) females and 131 (33.6%) males. The GPH summary scores ranged from 16.2 to 67.7 with a mean of 48.8 (SD = 8.9). Almost 44.6% of the study population has a GPH summary score of below 50; the GMH summary scores ranged from 28.4 to 67.6 with a mean of 50.8 (SD = 8.1). About 41.8% of the study population has a GMH summary score of below 50. Unemployment, household food insecurity and comorbidities with HIV were associated with both poor GPH and poor GMH summary scores. Age below 25 years and being a member of Christian fellowship were inversely associated with poor GPH. The least wealth index score and CD4 count below 350 cells/mL were also associated with poor GMH.

Conclusion

Overall, socioeconomic inequalities and HIV-related clinical factors play an important role in improving the HRQoL of PLHIV. Many of these determinants are alterable risk factors. Appropriate strategies can improve the holistic management of chronic HIV care and maximize PLHIVs’ HRQoL. Such strategies require the adoption of comprehensive interventions, including policies and programmes that would improve the health, wellbeing and livelihood of PLHIV.

Dietary Diversity and Associated Factors Among Adult HIV Positive Patients on Anti-Retroviral Therapy in Public Hospitals of Kembata Tembaro Zone, Southern Ethiopia

Background

Nutrition is a significant factor in all stages of HIV. Dietary management of HIV-positive patients is key to supporting their capacity to continue participating in the workforce and contributing to socio-economic growth. Few studies have been conducted regarding this important public health problem of dietary diversity throughout the developing countries including Ethiopia. Therefore, this study assesses the magnitude and factors associated with dietary diversity among HIV-positive patients attending antiretroviral therapy (ART) clinics at Public Hospitals in Kembata Tembaro Zoni, Southern Ethiopia.

Methods and Materials

An institutional-based cross-sectional study was conducted from January 01/2019 to 30/2019 on 341 adult HIV-positive patients on ART at two randomly selected public hospitals in the study area. A systematic random sampling technique was applied to select study subjects from each facility proportionally. Bivariable and multivariable logistic regression analyses were done to identify factors associated with individual dietary diversity. Logistic regression analysis with 95% confidence interval (CI) was estimated to measure the strength of association. Level of significance for statistical tests was set at p <0.05.

Results

This study shows 60.1% (95% CI: 55–65) of patients had inadequate dietary diversity. Average monthly income of less than 1000 Ethiopian Birr (AOR: 1.82, 95% CI: 1.04–3.17), being female (AOR = 2.99, 95% CI: 1.67–5.37), duration of ART less than 1 year (AOR = 3.77, 95% CI: 1.42–10.02) and lack of dietary counseling (AOR =0.54, 95% CI: 0.30–0.97) were factors associated with low dietary diversity.

Conclusion

Low dietary diversity was a major nutritional problem in HIV-positive patients. Low average monthly income, being female, duration of participants on ART, and lack of dietary counseling were the factors associated with low dietary diversity. To alleviate these problems, exceptional attention in nutritional care should be given to HIV-positive patients and they require appropriate counseling and support during early initiation of ART.

High magnitude of food insecurity and malnutrition among people living with HIV/AIDS in Ethiopia: A call for integration of food and nutrition security with HIV treatment and care Programme

BACKGROUND

Food insecurity and malnutrition has been reported to have a strong connection with human immunodeficiency viruses (HIV); this is more pervasive in Sub-Saharan Africa including Ethiopia. In this study, we examined the predictors of food insecurity and factors associated with malnutrition among people living with HIV (PLHIV) in Benishangul Gumuz Regional State, Ethiopia.

METHODS

We conducted a cross-sectional study at outpatient antiretroviral therapy (ART) clinics. Data were collected using participant interview, anthropometry, and participants' chart review. Interviews were carried out with 390 PLHIVs who were on antiretroviral treatment follow-up. Four robust multivariate linear regression models were used to identify predictors of food insecurity and factors associated with malnutrition.

RESULTS

The prevalence of food insecurity and malnutrition among PLHIV were found to be 76% and 60%, respectively. The predictors of food insecurity were: urban residence; household dependency; average monthly income below 53.19 USD; poor asset possession; CD4 count below 350 cell/μL; and recurrent episodes of opportunistic infections (OIs). Correspondingly, malnutrition among PLHIV was found strongly associated with: female gender; urban residence; income below 53.19 USD; poor asset possession; duration of less than one year on ART; and recurrent episodes of OIs.

CONCLUSION

The study findings suggest that the higher prevalence of food insecurity and malnutrition among PLHIV underscore: the need for economic and livelihood intervention; addressing contextual factors including the gender dimensions; adoption of nutrition-specific and sensitive interventions; and integration of food and nutrition security with HIV treatment and care programmes.

Food Insecurity among People Living with HIV/AIDS on ART Follower at Public Hospitals of Western Ethiopia

Background

Food insecurity and HIV/AIDS are intertwined in a vicious cycle through nutritional, mental health, and behavioral pathways. Food insecurity is a potentially important barrier to the success of antiretroviral treatment, increased hospitalizations, and higher morbidity among HIV-infected individuals in resource-poor settings particularly in sub-Saharan Africa including Ethiopia. Therefore, the purpose of this study was to assess the prevalence of food insecurity among people living with HIV/AIDS on follow up at public hospitals of western Ethiopia.

Methods

An institutional-based cross-sectional study design was conducted on a sample of 428 among people living with HIV/AIDS on follow up at public hospitals of western Ethiopia. A systematic random sampling technique was used to include all participants. Data was collected using interviewer-administered structured questionnaires. The data were entered into Epi data version 3.1 and then exported into Statistical Package for the Social Sciences window version 21 for analysis. Descriptive and inferential statistics were employed. Bivariable logistic and multivariable logistic analyses were used with AOR at CI 95% and p < 0.05 were used.

Result

The finding of the study revealed that the majority of the respondents 221(53.1%) were female. The mean age of the respondents was 32.92 ± 7.304 years and 197 (47.4%) of the study participants were between 30 to 39 years' age group. The level of food insecurity among PLWHA receiving ART therapy was 68.8% which was partitioned as mild (23.32%), moderate (29.09%), and severe (16.35%) food in secured. Being single [AOR = 3.507(1.377, 8.934)], illiterate [AOR = 5.234(1.747, 15.686)], cigarette smoking [AOR = 3.577(2.104, 6.081)], presence of anemia (AOR = 2.650(1.563, 4.493)], and inadequate dietary diversity [AOR = 2.870(1.088, 7.569)] were predictors of food insecurity.

Conclusion

The prevalence of food insecurity was high. Educational status, marital status, cigarette smoking, presence of anemia, opportunistic infection, and inadequate dietary diversity were the major significant factors affecting food insecurity. We recommended a national health policy maker to integrate food and nutrition interventions as part of a package of care, treatment, and support services for people living with HIV and ART follower patients.

Health related quality of life in patient with type 2 diabetes: The role of household food insecurity on latent class membership

BACKGROUND AND AIMS

Health related quality of life (HRQoL) is an important public health issue that mainly associated with a number of certain factors in medical sciences. This study, in particular, aimed to identify HRQoL latent subgroups among patients with type 2 diabetes and assess the role that household food insecurity (HFI) plays in classifying participants to each latent class.

METHODS

At the present cross sectional study, all the diabetic patients of the rural regions of Neyshabur (a city in north-east of Iran) were recruited between April and July 2012 (N = 1847). Latent Class Analysis (LCA) was used to determine the latent subgroups of HRQoL. Finally, LCA was used to determine the effect of HFI on dedicating participants to each latent class after adjusting other covariates.

RESULTS

Based on the subscales of HRQoL, three latent classes were identified, including: 1) poor HRQoL (34.6%), 2) moderate HRQoL (39.1%) and 3) good HRQoL (26.3%). After considering the possible confounders, having HFI decrease the odds of membership in latent class 2 (moderate HRQoL) (OR = 0.42, 95% CI: 0.29-0.60). Also having HFI show similar effect on latent class 3 (good HRQoL) and decrease the odds of membership in this class (OR = 0.13, 95% CI: 0.08-0.20) in compared to the first class (poor HRQoL).

CONCLUSIONS

Results from the present study show that HFI plays an important role in decreasing the odds of membership in moderate and good HRQoL classes compared to poor HRQoL.

Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings

While food insecurity and poverty worsen mental health outcomes among people living with HIV/AIDS (PLHIV), few intervention studies have targeted poverty and food insecurity as a way to improve mental health. Among HIV-positive patients, addressing such upstream determinants may prove crucial to ensure better mental health and HIV clinical outcomes. We integrated longitudinal, qualitative research into a randomized trial of a livelihood intervention to understand processes and mechanisms for how the intervention may affect mental health among HIV-infected Kenyan adults. In-depth interviews were conducted with intervention participants (n = 45) and control participants (n = 9) at two time-points (after intervention start and upon intervention end). Interviews (n = 85) were translated, double-coded, and analyzed thematically using an inductive-deductive team approach. Participants reported numerous mental health improvements post-intervention including reduced stress, fewer symptoms of anxiety, improved mood, lower depressive symptoms, fewer repetitive and ruminating thoughts, and more hopefulness for the future. Improvements in mental health appear to occur via several mechanisms including: 1) better food security and income; 2) increased physical activity and ability to create fruitful routines around farm work; and, 3) improved sense of self as an active member of the community. Qualitative, longitudinal interviews may help identify intervention mechanisms for improved mental health, but additional research is required to confirm self-reports of mental health changes. These findings suggest that livelihood interventions may improve mental health in multi-faceted ways, and help PLHIV better integrate with their communities. Trial registered at ClinicalTrials.gov: NCT01548599.

Psychosocial Factors Associated with Food Insufficiency Among People Living with HIV/AIDS (PLWH) Initiating ART in Ethiopia

Food insufficiency is associated with suboptimal HIV treatment outcomes. Less is known about psychosocial correlates of food insufficiency among PLWH. This sample includes 1176 adults initiating antiretroviral therapy at HIV clinics in Ethiopia. Logistic regression modeled the association of psychological distress, social support, and HIV-related stigma with food insufficiency. Among respondents, 21.4% reported frequent food insufficiency. Psychological distress [adjusted odds ratio (aOR) 2.61 (95% CI 1.79, 3.82)], low social support [aOR 2.20 (95% CI 1.57, 3.09)] and enacted stigma [aOR 1.69 (95% CI 1.26, 2.25)] were independently associated with food insufficiency. Food insufficiency interventions should address its accompanying psychosocial context.

Food Insecurity and Subjective Wellbeing Among Arab Youth Living in Varying Contexts of Political Instability

PURPOSE

To investigate associations between food insecurity experience and subjective wellbeing in Arab youth, across different political stability settings.

METHODS

Data from the Gallup World Poll (2014-2015) were extracted for youth aged 15-24 years living in 19 Arab countries (n = 8,162). Food insecurity was assessed using the Food Insecurity Experience Scale. Life Evaluation Score and Affect Balance were used as indicators of youth wellbeing. The 2014 Political Stability and Absence of Violence and Terrorism score was used to stratify Arab countries into three categories; high, medium, and low political stability. Multivariable regressions were performed to explore the relationship between food insecurity and wellbeing indices adjusting for socio-demographic and socio-economic factors, across different political stability settings.

RESULTS

The prevalence of food insecurity among Arab youth ranged between 3.1% in Lebanon to 91.3% in South Sudan. Food insecurity (moderate and severe) was negatively correlated with life evaluation (β: -0.74 for moderate food insecurity; -1.28 for severe food insecurity, p-value <0.001), and affect balance (β: -22.03 for moderate food insecurity; -33.88 for severe food insecurity, p-value <0.001). These results were consistent across political stability groups, independently from socio-demographic and socio-economic factors. Fewer factors were correlated with life evaluation and affect balance in low as compared to medium and high political stability settings.

CONCLUSIONS

Food insecurity is an independent risk factor for Arab youth wellbeing. Efforts to improve youth wellbeing can be channelled through food security interventions.

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.

Effectiveness of macronutrient supplementation on nutritional status and HIV/AIDS progression: A systematic review and meta-analysis

BACKGROUND & AIMS

Malnutrition is common in Sub-Saharan Africa, weakening the immune function of persons living with HIV infection (PLWH). Being malnourished at the initiation of antiretroviral therapy (ART) leads to higher risk of early mortality and reduced quality of life. Thus, introduction of protein-energy-fortified macronutrient supplements at ART initiation may improve HIV treatment outcomes. This review aimed to evaluate the effectiveness of macronutrient interventions.

METHODS

This systematic review and meta-analysis included 15 studies conducted from 2000 to 2015 among Sub-Saharan African adults.

RESULTS

Six randomized controlled trials and 4 retrospective cohort studies provided data eligible for a meta-analysis. Supplementation significantly increased the overall standardized mean difference (SMD) between baseline and follow-up data in weight (SMD = 0.382, p < .001), BMI (SMD = 0.799, p < .001); fat-free mass (SMD = 0.154, p = .009); and CD4 count (SMD = 0.428, p < .001).

CONCLUSION

Protein-energy-fortified macronutrient supplementation at ART initiation may positively influence nutritional status and immunologic response in PLWH in Sub-Saharan Africa.

Higher vegetable intake and vegetable variety is associated with a better self-reported health-related quality of life (HR-QoL) in a cross-sectional survey of rural northern Ghanaian women in fertile age

Background

A higher vegetable intake plays an important role in promoting general health and well-being, but there is a dearth of data on the independent effect of vegetable intake on health-related quality of life (HR-QoL). This study contributes to evidence on the independent effect of vegetable consumption on HR-QoL among women in fertile age.

Methods

A cross-sectional study of a sample of rural women in fertile age (15–49 years, n = 187), randomly selected from 6 rural communities in the Tolon and Savelugu Districts, Northern Region of Ghana. Vegetable consumption in the past month was assessed with a 27-item semi-quantitative food frequency questionnaire; self-reported HR-QoL with the Short Form Health Survey (SF-36); nutritional status with anthropometry; household food security with the household hunger scale (HHS) and demographic and socio-economic related covariates with a pre-tested semi-structured questionnaire using face-face interviews. Generalised Linear Models were fitted to assess adjusted mean scores and their 95% confidence intervals (95% CIs) by terciles of vegetable intake and vegetable variety score (VVS) for the HR-QoL, its physical health (PH) and mental health (MH) domains and the SF-36 subscales.

Results

The mean vegetable intake of the women was 324.6 ± 196.1 g/day. The mean scores of the HR-QoL, PH and MH were 69.5 ± 13.6, 72.6 ± 17.4 and 66.4 ± 12.6 respectively. The alpha Cronbach measure of reliability for the HR-QoL, PH and MH were 0.78, 0.75 and 0.62 respectively. After adjusting for potential confounders such as age, body-mass-index (BMI), parity, educational status, occupation, marital status, HHS and household asset index, we observed an increasing trend across terciles of vegetable intake in the past month for the HR-QoL (P-trend = 0.0003), PH (P-trend = 0.02), MH (P-trend = 0.001) as well as the physical functioning (P-trend = 0.01), role-physical (P-trend <.0001), and role emotional (P-trend <.0001) domains of the SF-36. The multivariate model of the results also showed a significant increasing trend in the adjusted mean scores of the HR-QoL (P-trend = 0.04), MH (P-trend = 0.001) as well as 4 subscales of the SF-36 [role-physical (P-trend = 0.02), role-emotional (P-trend = 0.05), emotional well-being (P-trend = 0.002) and vitality (P-trend <.0001)] across terciles of the VVS.

Conclusion

The results of the present study suggest a potential beneficial role of high vegetable intake and consumption of more varied vegetables on HR-QoL. Further research is needed to determine the mechanisms driving these influences.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5845-3) contains supplementary material, which is available to authorized users.

Food security and dietary diversity are associated with health related quality of life after 6 months of follow up among people living with HIV in Accra, Ghana

With the efficacy of antiretroviral therapy, people living with HIV (PLWH) are surviving longer and improving their health related quality of life (HRQol) has become an important long-term HIV treatment and management indicator. HRQol has been associated with various factors, including food insecurity (FI). The objective of this prospective study was to examine the association between FI and dietary diversity (HDDS) and HRQol among PLWH in Accra, Ghana. We recruited 152 PLWH from the HIV clinics of six district hospitals Accra, Ghana and utilized a prospective cohort study design with data collection at baseline, three and six months after recruitment for this study. Participants completed questionnaires measuring HRQol, FI and HDDS. Repeated measures ANOVA was used to analyze the associations between FI and HRQol as well as HDDS and HRQol separately and then together. Being food secure [0.035 (95% CI = 0.005, 0.065)] and having a high dietary diversity score [0.029 (95% CI = 0.004, 0.053)] were independently associated with an improvement in quality of life scores over time after adjusting for other covariates and each other. Interventions to improve dietary diversity and food security among PLWH have the potential to improve nutritional status as well as HRQol.

Investigating the interaction between human immunodeficiency virus, nutrition, and disability: A cross-sectional observational study

Background

The average lifespan of people with human immunodeficiency virus (HIV) has increased because of the enhanced access to anti-retroviral treatment. This increased longevity has led to a heightened focus on the comorbidities which may arise, allowing a clearer understanding of the contextual, personal, psychological and functional problems and their interrelations. Disability (functional limitations) and insufficient nutritional intake may interact cyclically with HIV and/or acquired immunodeficiency syndrome (AIDS); however, no research to date has investigated this interaction.

Aims

The objective of this article was to report on the nutritional outcomes using albumin and body mass index outcomes as a subset of a larger study among adults living with HIV and/or AIDS.

Setting

This study was conducted at a large HIV clinic based in an urban area in Johannesburg, South Africa, which provides HIV treatment and support to over 6000 persons with HIV and TB. This clinic is part of a large public health regional hospital where extensive HIV research is undertaken.

Methods

This study was a cross-sectional observational study. The sample composed of 278 participants between 18 and 65 years of age and had been on highly active antiretroviral therapy (HAART) for more than six months. Statistical analyses were performed using the Statistical Package for the Social Sciences.

Results

The results indicated that albumin level had significant inverse associations with functional limitations and physical health symptoms. Women were significantly more likely to have lower nutritional levels. A logistic regression analysis suggested that gender and physical health symptoms were the primary predictors of albumin levels.

Conclusion

The findings presented in this article can be applied to HIV and/or AIDS treatment programmes, such as HAART. It re-emphasises the importance of providing individuals on anti-retroviral therapy with affordable and adequate nutrition, education on the importance of nutritional intake and the benefits of potentially adopting supplement programmes. As females seem to be more adversely affected by low nutritional levels, with the findings showing an increased likelihood of developing physical health symptoms, focus also needs to be given to cultural or social factors that impact nutritional intake in women.

Socioeconomic correlates of dietary diversity and its association with adherence and psychosocial functioning of people living with HIV in rural Zambia

BACKGROUND

The intersection of nutrition and HIV underscores the importance of adequate food and a diverse diet. In communities with high prevalence of food insecurity and HIV, there is a substantial co-occurrence of low dietary diversity, undernutrition, and adverse health outcomes.

AIM

The aim of this study was to identify correlates of individual dietary diversity (IDD) and its association with health outcomes for people living with HIV (PLHIV) in rural Zambia.

METHODS

The study used a cross-sectional design using data from 101 PLHIV. We calculated IDD using a composite score based on dietary diversity, food frequency, and the relative nutritional importance of different food groups. Adherence was measured using the visual analog scale. Psychosocial functioning was measured using the Structural Barriers to Medication-taking Scale and the Perceived Stress Scale. Data were analyzed using linear and logistic regressions. Multiple imputation was conducted to address missing data.

RESULTS

Staples were the most commonly consumed food group. Income and household size were negatively associated with IDD scores. Assets were positively associated with IDD scores. Residing in Lundazi and having a poor or fair self-rated health were associated with lower IDD scores. IDD was also associated, albeit not significant, with desirable health outcomes, including adherence and lower levels of perceived barriers to pill taking and stress.

CONCLUSIONS

Findings suggest a heterogeneous effect of socioeconomic variables on IDD. Understanding this heterogeneity is important for the design of interventions. Interventions that combine opportunities to generate economic resources with food and nutrition coaching may be appropriate and effective.

Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study

BACKGROUND

Food insecurity contributes to poor health outcomes among people living with HIV. In Latin America and the Caribbean, structural factors such as poverty, stigma, and inequality disproportionately affect women and may fuel both the HIV epidemic and food insecurity.

METHODS

We examined factors contributing to food insecurity among women living with HIV (WLHIV) in the Dominican Republic (DR). Data collection included in-depth, semi-structured interviews in 2013 with 30 WLHIV with indications of food insecurity who resided in urban or peri-urban areas and were recruited from local HIV clinics. In-person interviews were conducted in Spanish. Transcripts were coded using content analysis methods and an inductive approach to identify principal and emergent themes.

RESULTS

Respondents identified economic instability as the primary driver of food insecurity, precipitated by enacted stigma in the labor and social domains. Women described experiences of HIV-related labor discrimination in formal and informal sectors. Women commonly reported illegal HIV testing by employers, and subsequent dismissal if HIV-positive, especially in tourism and free trade zones. Enacted stigma in the social domain manifested as gossip and rejection by family, friends, and neighbors and physical, verbal, and sexual abuse by intimate partners, distancing women from sources of economic and food support. These experiences with discrimination and abuse contributed to internalized stigma among respondents who, as a result, were fearful and hesitant to disclose their HIV status; some participants reported leaving spouses and/or families, resulting in further isolation from economic resources, food and other support. A minority of participants described social support by friends, spouses, families and support groups, which helped to ameliorate food insecurity and emotional distress.

CONCLUSIONS

Addressing food insecurity among WLHIV requires policy and programmatic interventions to enforce existing laws designed to protect the rights of people living with HIV, reduce HIV-related stigma, and improve gender equality.

A Multilevel Conceptual Framework to Understand the Role of Food Insecurity on Antiretroviral Therapy Adherence in Low-Resource Settings: From Theory to Practice

The objective of this study was to describe a multilevel conceptual framework to understand the role of food insecurity on antiretroviral therapy adherence. The authors illustrated an example of how they used the multilevel framework to develop an intervention for poor people living with HIV in a rural and low-resource community. The framework incorporates intrapersonal, interpersonal, and structural-level theories of understanding and changing health behaviors. The framework recognizes the role of personal, social, and environmental factors on cognition and behavior, with particular attention to ways in which treatment adherence is enabled or prevented by structural conditions, such as food insecurity.

Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia

BACKGROUND

Malnutrition hastens progression to Acquired Human Immunodeficiency Syndromes (AIDS) related illnesses; undermines adherence and response to antiretroviral therapy (ART) in resource-poor settings. However, nutritional status of people living with HIV (PLHIV) can be affected by various psychosocial factors which have not been well explored in Ethiopia. Therefore, the objective of this study was to determine psychosocial correlates of nutritional status among people living with HIV (PLHIV) on ART in Central zone of Tigray, Northern Ethiopia.

METHODS

A matched case-control study design was conducted to assess psychosocial correlates of nutritional status among PLHIV on ART. Data were collected by an interviewer-administered technique using structured pre-tested questionnaire, record review using a checklist and anthropometric measurements. Cases were selected by simple random sampling and controls purposively to match the selected cases. Conditional logistic regression was used to compute relevant associations by STATA version 12.

RESULTS

The psychosocial factors independently associated with malnutrition were ever consuming alcohol after starting ART [AOR = 4.7, 95% CI: 1.8-12.3], ever smoking cigarette after starting ART [AOR = 7.6, 95% CI: 2.3-25.5], depression [AOR = 2.8, 95% CI: 1.3, 6.1], not adhering to ART [AOR = 6.8,95% CI: 2.0-23.0] and being in the second lowest wealth quintile [AOR = 4.3,95% CI: 1.1-17.7].

CONCLUSION

Ever consuming alcohol and ever smoking cigarette after starting ART, depression, not adhering to ART and being in the second lowest wealth quintile were significantly associated with malnutrition. Therefore; policies, strategies, and programs targeting people living with HIV should consider psychosocial factors that can impact nutritional status of people living with HIV enrolled on ART.

Poverty and perceived stress: Evidence from two unconditional cash transfer programs in Zambia

INTRODUCTION

Poverty is a chronic stressor that can lead to poor physical and mental health. This study examines whether two similar government poverty alleviation programs reduced the levels of perceived stress and poverty among poor households in Zambia.

METHOD

Secondary data from two cluster randomized controlled trials were used to evaluate the impacts of two unconditional cash transfer programs in Zambia. Participants were interviewed at baseline and followed over 36 months. Perceived stress among female caregivers was assessed using the Cohen Perceived Stress Scale (PSS). Poverty indicators assessed included per capita expenditure, household food security, and (nonproductive) asset ownership. Fixed effects and ordinary least squares regressions were run, controlling for age, education, marital status, household demographics, location, and poverty status at baseline.

RESULTS

Cash transfers did not reduce perceived stress but improved economic security (per capita consumption expenditure, food insecurity, and asset ownership). Among these poverty indicators, only food insecurity was associated with perceived stress. Age and education showed no consistent association with stress, whereas death of a household member was associated with higher stress levels.

CONCLUSION

In this setting, perceived stress was not reduced by a positive income shock but was correlated with food insecurity and household deaths, suggesting that food security is an important stressor in this context. Although the program did reduce food insecurity, the size of the reduction was not enough to generate a statistically significant change in stress levels. The measure used in this study appears not to be correlated with characteristics to which it has been linked in other settings, and thus, further research is needed to examine whether this widely used perceived stress measure appropriately captures the concept of perceived stress in this population.

Alcohol Use and Food Insecurity Among People Living with HIV in Mbarara, Uganda and St. Petersburg, Russia

Food insecurity (FI) is a documented problem associated with adverse health outcomes among HIV-infected populations. Little is known about the relationship between alcohol use and FI. We assessed whether heavy alcohol use was associated with FI among HIV-infected, antiretroviral therapy (ART)-naïve cohorts in Uganda and Russia. Inverse probability of treatment weighted logistic regression models were used to evaluate the association using cross-sectional baseline data. FI was experienced by half of the Russia cohort (52 %) and by a large majority of the Uganda cohort (84 %). We did not detect an association between heavy alcohol use and FI in either cohort (Russia: AOR = 0.80, 95 % CI 0.46, 1.40; Uganda: AOR = 1.00, 95 % CI 0.57, 1.74) or based on the overall combined estimate (AOR = 0.89, 95 % CI 0.60, 1.33). Future studies should explore the determinants of FI in HIV-infected populations to inform strategies for its mitigation.

Food Security Status is Related to Mental Health Quality of Life Among Persons Living with HIV

This study evaluated the association between health related quality of life and food security among persons living with HIV (PLHIV). We studied 167 PLHIV who completed questionnaires assessing food security, disease symptomatology, and several domains of the SF-36 health related quality of life survey. HIV disease state was assessed from medical records. Associations between independent and outcome variables were determined through linear regression models. Compared to food security, very low food security was significantly associated with lower mental component summary scores, [average difference -4.98 (95 % CI -9.85, -0.10)]; mental health, [average difference -5.44 (95 % CI -10.08, -0.81)]; and general health, [average difference -5.13 (95 % CI -9.65, -0.65)] after adjusting for covariates. About a fourth of participants experienced severe food insecurity, which negatively influenced their mental health and general wellbeing. The inclusion of resources for food assistance in HIV treatment programs may help ameliorate mental health challenges faced by PLHIV.

Food insecurity among students living with HIV: Strengthening safety nets at the Nelson Mandela Metropolitan University, South Africa

The HIV prevalence in South Africa among students at higher education institutions (HEIs) in 2008 was reported to be 3.4%, with the highest HIV prevalence found in the Eastern Cape Province. Students at these facilities are also increasingly affected by socio-economic constraints that may impact on food security. Little is known about the impact of food insecurity on HIV-infected students in HEIs in South Africa. The purpose of this paper is to describe food insecurity and the nutritional status among HIV-infected students on the Nelson Mandela Metropolitan University campuses in South Africa, as well as current initiatives to strengthen the safety nets for food-insecure students. This descriptive, cross-sectional survey was conducted among a convenience sample of known HIV-infected, registered students (n = 63), older than 18 years of age and managed as part of the Campus Health Service antiretroviral therapy (ART) programme. Ethical approval for the study was obtained from the Research Ethics Committee (NMMU) and participants were included in the sample after providing written, informed consent. Findings indicate that food insecurity was common with more than 60% of the sample reporting food insecurity at the household level during the previous month. Of the sample, 51% were classified as being either overweight or obese. Although food insecurity did not contribute to weight loss in our sample, food-insecure students were more likely to consume inadequate amounts of vitamins and minerals, especially antioxidants that are important in supporting the immune system. Food insecurity has been identified as affecting the majority of HIV-infected students in this study, especially regarding their difficulty in accessing nutritious foods. As overweight and obesity also seem to threaten the health and future well-being of the students, appropriate management of the overweight individuals and those with obesity should be instituted in order to prevent the development of chronic diseases of lifestyle, thus allowing for a healthier more productive life. Current intervention strategies to strengthen food security have made inroads to improve access to healthier food options.

Gender Differences and Psychosocial Factors Associated with Quality of Life Among ART Initiators in Oromia, Ethiopia

Health-related quality of life (HRQoL) is an important outcome to assess among persons living with HIV/AIDS, but few studies have been conducted in sub-Saharan Africa. We examined HRQoL among 1180 ART-initiating adults from six clinics in Ethiopia in 2012-2013, and compared the correlates of two subscale scores between women and men. Women scored significantly higher than men on both overall function (8.4 points higher) and life satisfaction (6.3 points higher). In multivariable models, psychological distress, low CD4+ count, unemployment, and food insecurity were associated with lower quality of life scores among women and men. Men whose last sexual encounter occurred 3 months to 1 year from the interview date had lower overall function and life satisfaction scores. Men between the ages of 30-39 had lower overall function scores. Protestant women and women in the low-middle social support category had lower life satisfaction scores. Assessment of HRQoL over time will help inform HIV care and treatment practices to ensure favorable patient outcomes.

The effect of nutritional supplementation on quality of life in people living with HIV: a randomised controlled trial

OBJECTIVE

To determine the effects of lipid-based nutrient supplements (LNS) on the quality of life of people living with HIV (PLHIV) during the first 3 months of antiretroviral treatment (ART) and to investigate the effects of timing of supplementation by comparing with supplementation during the subsequent 3 months.

METHODS

A randomised controlled trial was conducted in three ART clinics within public health facilities in Jimma, Ethiopia. Participants were PLHIV eligible to start ART with body mass index >17 kg/m(2) and given daily supplements of 200 g of LNS containing whey or soya either during the first 3 months or the subsequent months of ART. The outcome was measured in terms of total quality-of-life scores on the adapted version of the WHOQOL-HIV-BREF assessed at baseline, three and six months.

RESULTS

Of the 282 participants, 186 (66.0%) were women. The mean age (SD) was 32.8 (±9.0) years, and the mean (SD) total quality-of-life score was 82.0 (±14.8) at baseline assessment. At 3 months, participants who received LNS showed better quality of life than those who only received ART without LNS (β = 6.2, 95% CI: 2.9: 9.6). At 6 months, there was no difference in total quality-of-life score between the early and delayed supplementation groups (β = 3.0, 95% CI: -0.4: 6.4). However, the early supplementation group showed higher scores on the social and spirituality domains than the delayed group.

CONCLUSIONS

LNS given during the first three months of ART improves the quality of life of PLHIV.

Food insecurity, mental health and quality of life among people living with HIV commencing antiretroviral treatment in Ethiopia: a cross-sectional study

BACKGROUND

Studies from high-income settings show that both food insecurity and common mental disorders (CMDs) are associated with lower quality of life among people living with HIV (PLHIV). However, there is limited research among PLHIV in sub-Saharan Africa. In this study we tested the hypothesis that food insecurity and CMDs would be associated with poorer quality of life of PLHIV in Ethiopia.

METHODS

A cross-sectional study was carried out with 348 PLHIV who were initiating antiretroviral therapy recruited from two primary care centers and a tertiary Hospital in southwest Ethiopia. Food insecurity, CMD, and quality of life were measured using instruments adapted and validated in Ethiopia (Household Food Insecurity Access Scale, Kessler-6, and WHOQOL-HIV-BREF-ETH, respectively). Multiple linear regression analysis was used to identify factors associated with quality of life after adjusting for confounders.

RESULTS

The prevalence of severe household food insecurity among PLHIV was 38.7 %. After adjusting for confounders, severe food insecurity (β = -3.24, 95 % CI: -6.19; -0.29) and higher levels of CMD symptoms (β = -1.72 for each 1 point increase, 95 % CI: -1.94; -1.49) were associated with lower quality of life. Other factors associated with lower quality of life were advanced HIV disease (β = -3.80, 95 % CI: -6.18; -1.42), and being underweight (BMI = 17.0 - 18.5 kg/m(2)) (β = -3.45, 95 % CI: -6.18; -0.71). Owning more household assets was associated with higher quality of life (β = 0.99 for owning one more asset, 95 % CI: 0.09; 1.89).

CONCLUSION

Poor mental health and food insecurity are associated with lower quality of life in PLHIV. There is a need for longitudinal studies to elucidate the pathways linking CMD, food insecurity and quality of life.

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.

Improving Health-Related Quality of Life among People Living with HIV: Results from an Impact Evaluation of a Food Assistance Program in Uganda

Introduction

Widespread food insecurity in Africa continues to compromise an effective response to the AIDS epidemic. Health-related quality of life (HRQoL) is a comprehensive indicator of physical, mental, and social well-being that is associated with food insecurity and increasingly used to assess the well-being of people living with HIV/AIDS (PLHIV). We examined the impact of a food assistance intervention, previously shown to have reduced household food insecurity and improved nutritional status, on HRQoL of PLHIV.

Methods

We capitalized on an existing intervention targeting antiretroviral therapy (ART)- naïve PLHIV in Uganda, and conducted a prospective impact evaluation including a treatment and a comparison group. Data analyzed included 640 participants from two districts (318 in the intervention district) interviewed in both clinic and household settings at baseline and again approximately one year later. The main outcomes considered were physical and mental health dimensions of HRQoL, and other outcomes included self- and healthcare provider-reported symptoms. We utilized difference-in-difference propensity score matching methodologies to infer causality and examine program impacts.

Results

Over 12 months, food assistance significantly increased physical health scores (PHS) by 2.85 (P < .01) or approximately 0.35 SD, and reduced substantially the number of self- and healthcare provider-reported HIV-related symptoms by 3.83 and 2.68, respectively (P < .01). There was no significant impact, however, on mental health scores (MHS).

Conclusions

This study demonstrates the potential importance for HRQoL of including food assistance programming as part of the standard of care for PLHIV in areas of widespread food insecurity.

Food Insecurity and Its Relation to Psychological Well-Being Among South Indian People Living with HIV

Food insecurity (FI) and its link with depression and quality of life (QOL) among people living with HIV (PLHIV) in India are not well-documented. We analyzed cohort data from 243 male and 129 female PLHIV from Bengaluru, and found 19 % of men and 26 % of women reported moderate or severe FI over a 6-month period. Women reported higher mean depression than men, and lower mean QOL. In multivariate analyses adjusting for HIV stigma and demographic covariates, both male and female PLHIV with moderate to severe FI showed lower mean QOL than those reporting mild to no FI. Male but not female food insecure participants also had higher depression scores in adjusted regression analyses. As ART has improved the physical health of PLHIV, more effort is being invested in improving their psychological well-being. Our results suggest such interventions could benefit from including nutritional support to reduce FI among PLHIV.

Nutritional status and its association with quality of life among people living with HIV attending public anti-retroviral therapy sites of Kathmandu Valley, Nepal

Background

Little evidence exists on the connections between nutrition, diet intake, and quality of life (QoL) among people living with HIV (PLHIV). The study aimed to estimate the prevalence of under-nutrition among PLHIV in Nepal, and identify risk factors and assess correlations with PLHIVs’ QoL and nutritional status.

Methods

This quantitative cross-sectional study used Body Mass Index (BMI) as an indicator for nutritional status, and additional information on opportunistic infections (OIs), CD4 count, and World Health Organization (WHO) clinical staging was collected from medical records. Participants were asked to complete surveys on food security and QoL. Descriptive analysis was used to estimate the prevalence of under nutrition. To assess associations between nutrition status and independent variables, bivariate and multivariate analysis was completed. Spearman’s rank correlation test was used to assess the association between nutritional status and QoL.

Results

One in five PLHIVs was found to be under nourished (BMI <18.5 kg/m²). Illiteracy, residence in care homes, CD4 cells count <350 cells/mm³, OIs, and illness at WHO clinical stages III and IV were found to be significant predictors of under nutrition. BMI was significantly correlated with three domains of QoL (psychological, social and environmental).

Conclusion

Nutrition interventions should form an integral part of HIV care programs. Understanding the presence of OI, decline in CD4 count, and advancing WHO clinical stages as risk factors can be helpful in preventing under nutrition from developing. Longitudinal research is necessary to further explicate associations between nutritional status and QoL.

Quality of life and wellbeing among HIV outpatients in East Africa: a multicentre observational study

Background

Global health investment has reduced HIV mortality and transmission. However, little is known of patient-reported outcomes alongside ART rollout. This study aimed to measure wellbeing using patient-reported outcome measures (PROMS) among outpatients at PEPFAR-funded facilities.

Methods

In a multicentre 2 country cross-sectional study, adults attending 12 facilities in Kenya and Uganda gave self-reported data on quality of life (physical and mental wellbeing dimensions), functional and a measure of multidimensional problems (physical, psychological, social and spiritual).

Results

Among the 1,337 participants, multidimensional problems were more common in psychological, spiritual and social domains than in physical. In multivariable analysis using GEE to adjust for facility effect, the mental health subscale of quality of life was lower for people with limited functional status (B = -5.27, 95% CI -5.99, 1. -4.56 p < 0.001) and higher for wealthier people (B = 0.91, 95% CI 0.48, 1.33, p < 0.001). The physical health subscale of quality of life was lower for those with limited functional status (B = -8.58, 95% CI -9.46 to -7.70, p < 0.001) and those who had a caregiver present (B = -1.97, 95% CI -3.72 to -0.23, p = 0.027), higher for wealthier people (B = 1.14, 95% CI 0.65, 1.64, p < 0.001), and positively associated with CD4 count (B = 1.61, 95% CI 1.08-2.14, p < 0.001). Multidimensional problems were more burdensome for people with limited functional status (B = -2.06, 95% CI -2.46 to -1.66, p < 0.001), and less burdensome with more education (B = 0.63, 95% CI 0.25-1.00, p = 0.001) or ART use (B = 0.94, 95% CI 0.34-1.53, p = 0.002).

Conclusions

Multidimensional problems are highly prevalent, and worse with declining function. Importantly, ART use does not appear to be protective for self-reported physical and mental dimensions of quality of life. Assessment and management of self-reported wellbeing must form part of HIV care and treatment services to ensure maximum benefit from ART investment.

Association of Supplemental Nutrition Assistance Program (SNAP) with health related quality of life and disease state of HIV infected patients

The literature on the potential clinical and non-clinical benefits of participation in food assistance programs for people living with HIV in developed countries is scarce. We conducted a cross-sectional study of 165 HIV infected adults to determine the impact of the Supplemental Nutrition Assistance Program (SNAP) on HIV disease status and health related quality of life (HQROL). There was no significant association between SNAP participation and disease status; CD4 cell count (β = 0.02, P = 0.837) and viral load (β = 0.02, P = 0.836). The mean scores for all the HRQOL domains were lower compared to the US population, but none were associated with SNAP participation. Higher scores on the general health domain, were marginally associated with SNAP participation (β = 0.16, P = 0.071). In this study, SNAP participation was not significantly associated with less disease progression, and only marginally associated with quality of life among this population of HIV infected individuals.

Food security and nutrition interventions in response to the AIDS epidemic: assessing global action and evidence

The number of people receiving antiretroviral therapy in developing countries has increased dramatically. The last decade has brought an increased understanding of the interconnectedness between HIV/AIDS, food insecurity, and undernutrition and a surge of evidence on how to address the food security and nutrition dimensions of the epidemic. We review this evidence as well as the corresponding evolution of policy support for incorporating food security and nutrition concerns into HIV programming. The available evidence, although varied in scope and methodologies, shows that nutrition supplementation and safety nets in the form of food assistance and livelihood interventions have potential in certain contexts to improve food security and nutrition outcomes in an HIV/AIDS context. In the face of funding uncertainties and competing priorities, we must maintain momentum towards effective and sustainable solutions to the epidemic through continued systematic research to inform policy and through the strengthening of monitoring systems to dynamically inform intervention development.

The impact of a food assistance program on nutritional status, disease progression, and food security among people living with HIV in Uganda

BACKGROUND

Although the last decade has seen increased access to antiretroviral therapy across the developing world, widespread food insecurity and undernutrition continue to compromise an effective response to the AIDS epidemic. Limited evidence exists on the potential benefit of food security and nutrition interventions to people living with HIV (PLHIV).

METHODS

We capitalized on an existing intervention to PLHIV in Uganda and conducted a prospective quasi-experimental study evaluating the impact of a monthly household food basket, provided to food insecure antiretroviral therapy-naive PLHIVs for 12 months. The outcomes of interest measured at baseline and follow-up were nutritional status [body mass index; mid-upper arm circumference and hemoglobin (Hb) concentrations], disease severity (CD4 count), and 2 measures of food security: diet quality (Individual Dietary Diversity Score) and food access (Household Food Insecurity Access Scale). We used difference-in-difference propensity score matching to examine the impact of food assistance.

RESULTS

Over 12 months, food assistance significantly increased body mass index by 0.6 kg/m (P < 0.01) and mid-upper arm circumference by 6.7 mm (P < 0.05). We found no impact on CD4 count, Hb concentrations, or Individual Dietary Diversity Score. Restricting the analysis to individuals with CD4 counts of greater than 350 cells per microliter, there were significant impacts on Hb concentrations (1.0 g/dL; P < 0.05). At the household level, food assistance increased the Household Food Insecurity Access Scale, by 2.1 points (P < 0.01).

CONCLUSIONS

This study demonstrates the potential for food assistance programming to be part of the standard of care for PLHIV in areas of widespread food insecurity.

Cost-effectiveness of community vegetable gardens for people living with HIV in Zimbabwe

BACKGROUND

There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs.

METHODS

This analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey.

RESULTS

Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished.

CONCLUSIONS

Cost outcomes were 20-30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.