Food Insecurity Is Associated with Increased Risk of Non-Adherence to Antiretroviral Therapy among HIV-Infected Adults in the Democratic Republic of Congo: A Cross-Sectional Study

Abstract

BackgroundFood insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC).Methods and FindingsThis is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38–3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15–3.32) and decreased (AOR, 0.31; CI, 0.11–0.83) odds of non-adherence to ART.ConclusionFood insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa.

Patient Factors Influencing Adherence to ART Treatment among HIV/AIDS Patients in Embu Teaching and Referral Hospital Comprehensive Care Clinic

“…Similar findings were made in Ethiopia where it was observed that unemployed patients were more likely to be depressed and less likely to socialize, leading to miss appointments and access to health care [23]. Similar findings were also made in Cameron where it was reported that adherence was high among employed patients as compared to unemployed patients [24]. Similar findings has been observed in low-income countries where it was found that overall pooled odds ratio (OR) for the association between being employed and adhering to ART was 1.85 [25].…”

Food insecurity and undernutrition in treated HIV patients a (post-) conflict setting: A cross sectional study from Goma, Eastern Democratic Republic of Congo

“…This sample size was calculated to correctly assess the proportion of HIV-infected individuals with food insecurity, based on the national data in the DRC of 57% [18]. The power calculation used the Kish-Leslie formula, with a 5 % level of precision, a confidence interval (CI) of 95 %.…”

“…A review of existing literature revealed that, unlike in resource-rich settings, limited data is available from validated measures of food insecurity that describe the association between food insecurity and nutritional status among patients on ART [17,18] in SSA. Especially the link between food insecurity and adherence to ART seems to relate to treatment failure.…”

“…Especially the link between food insecurity and adherence to ART seems to relate to treatment failure. Food insecurity, financial constraints, and fear of disclosure/stigma have been reported to be barriers to ART adherence among HIVpositive adults in the DRC [18]. Food security has been described as an important aspect in considering the wealth and economic sustainability of a nation.…”

Levels and Predictors of Food Insecurity among HIV Positive Adult Patients Taking Highly Active Anti-Retroviral Therapy at Arba Minch General Hospital, Southern Ethiopia, 2016

“…A cross-sectional study conducted in South Africa revealed that the physiological complications of progression of HIV infection and poverty were determinants of insufficient consumption of a diet of adequate quality and quantity to booster immune function and support medical therapy [28]. Studies conducted in different parts of Africa showed that HIV/AIDS depletes financial capital, social capital and human capital as labor is lost through decreased productivity and the death of the productive member of the family [29,30].…”