Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

“…These challenges are faced by up to 50% of Ontario residents with HIV and have been associated with poor health outcomes and heightened rates of emergency department use in several studies. [34][35][36][37][38] Second, our finding of high rates of emergency department visits related to mental health and substance use could be explained by earlier work highlighting a greater rela tive burden of mental health-related morbidity among Ontario residents with HIV and less engagement in continu ous HIV outpatient care among individuals with a history of injection drug use. 39,40 Although higher rates of infectious dis eases-related visits among people with HIV are not unex pected, only a minority of visits were related to underlying HIV infection.…”

Section: Discussionmentioning

confidence: 97%

Emergency department use by people with HIV in Ontario: a population-based cohort study

Kendall

Burchell

et al. 2016

CMAJ Open

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Background: Emergency department use may reflect poor access to primary care. Our objective was to compare rates and causes of emergency department use between adults living with and without HIV. Methods:We conducted a population-based study involving Ontario residents living with and without HIV between Apr. 1, 2011, and Mar. 31, 2012. We frequency matched adults with HIV to 4 HIV-negative people by age, sex and census division, and used randomeffects negative binomial regression to compare rates of emergency department use. We classified visits as low urgency or high urgency, and also examined visits for ambulatory care sensitive conditions. Hospital admission following an emergency department visit was a secondary outcome. Results:We identified 14 534 people with HIV and 58 136 HIV-negative individuals. Rates of emergency department use were higher among people with HIV (67.3 v. 31.2 visits per 100 person-years; adjusted rate ratio 1.58, 95% confidence interval [CI] 1.51-1.65). Similar results were observed for low-urgency visits. With the exception of hypertension, visit rates for ambulatory care sensitive conditions were higher among people with HIV. People with HIV were also more likely than HIV-negative individuals to be admitted to hospital following an emergency department visit (adjusted odds ratio 1.55, 95% CI 1.43-1.69). Interpretation

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“…Society incurs high costs from uncontrolled chronic disease such as T2DM [51], particularly among low-income, food-insecure, and/or underinsured populations who are more likely to delay care, use the emergency room, and require hospital inpatient services [52]. Identifying less resource-intensive ways to help individuals manage their illnesses in the context of competing subsistence needs is therefore critical for the optimal use of public funds.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

et al. 2017

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Food insecurity is associated with negative chronic health outcomes, yet few studies have examined how providing medically appropriate food assistance to food-insecure individuals may improve health outcomes in resource-rich settings. We evaluated a communitybased food support intervention in the San Francisco Bay Area for people living with HIV and/or type 2 diabetes mellitus (T2DM) to determine the feasibility, acceptability, and potential impact of the intervention on nutritional, mental health, disease management, healthcare utilization, and physical health outcomes. The 6-month intervention provided meals and snacks designed to comprise 100% of daily energy requirements and meet nutritional guidelines for a healthy diet. We assessed paired outcomes at baseline and 6 months using validated measures. Paired t tests and McNemar exact tests were used with continuous and dichotomous outcomes, respectively, to compare pre-post changes. Fifty-two participants (out of 72 initiators) had both baseline and follow-up assessments, including 23 with HIV, 24 with T2DM, and 7 with both HIV and T2DM. Median food pick-up adherence was 93%. Comparing baseline to follow-up, very low food security decreased from 59.6% to 11.5% (p < 0.0001). Frequency of consumption of fats (p = 0.003) decreased, while frequency increased for fruits and vegetables (p = 0.011). Among people with diabetes, frequency of sugar consumption decreased (p = 0.006). We also observed decreased depressive symptoms (p = 0.028) and binge drinking (p = 0.008). At follow-up, fewer participants sacrificed food for healthcare (p = 0.007) or prescriptions (p = 0.046), or sacrificed healthcare for food (p = 0.029). Among people with HIV, 95% adherence to antiretroviral therapy increased from 47 to 70% (p = 0.046). Among people with T2DM, diabetes distress (p < 0.001), and perceived diabetes self-management (p = 0.007) improved. Comprehensive, medically appropriate food support is feasible and may improve multiple health outcomes for food-insecure individuals living with chronic health conditions. Future studies should formally test the impact of medically appropriate food support interventions for food-insecure populations through rigorous, randomized controlled designs.

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Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco

Cited by 99 publications

References 80 publications

Measurement of the dimensions of food insecurity in developed countries: a systematic literature review

Measurement of the dimensions of food insecurity in developed countries: a systematic literature review

Emergency department use by people with HIV in Ontario: a population-based cohort study

Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health

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