Food Insufficiency and Medication Adherence Among People Living with HIV/AIDS in Urban and Peri-Urban Settings

Abstract

Food insufficiency is associated with medication non-adherence among people living with HIV/AIDS. The current study examines the relationship between hunger and medication adherence in a US urban and peri-urban sample of people living with HIV/AIDS. Men (N=133) and women (N=46) living with HIV/AIDS were recruited using snowball sampling and small media in Atlanta, Georgia. Participants completed computerized behavioral interviews that included measures of demographics, food insufficiency, social support, depression, and substance use, and provided blood specimens to determine HIV viral load. Participants also completed monthly unannounced pill counts to prospectively monitor medication adherence over 8 months. Results indicated that 45% of participants were less than 85% adherent to their medications and that food insufficiency was related to non-adherence; nearly half of non-adherent participants reported recent hunger. Geocoding of participant residences showed that 40% lived more than 5 miles from the city center. Multivariable logistic regression controlling for demographics and common factors associated with adherence showed that the interaction between distance from downtown and experiencing hunger significantly predicted non-adherence over and above all other factors. Medication adherence interventions should address access to food, particularly for people living outside of urban centers.

Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review

“…We were aware of two additional papers meeting inclusion criteria [37,38] from a previous review on food insecurity and ART adherence [39] that were not identified through the database search. Two papers on food insecurity and ART adherence were from the same study [40,41] presenting measures of association from overlapping samples of PLHIV, and both were included. Two additional papers were on sub-samples from a large survey population in Cameroon and both were included [42,43].…”

“…Twelve studies [13,37,38,[40][41][42][43][45][46][47][48][49] were cross-sectional, five were prospective cohort studies [15,16,[50][51][52], one was a retrospective cohort [53], and one was a case-control study [54]. One cross-sectional study [37] analyzed ART adherence as the exposure and food insecurity as the outcome (the inverse of the pathway of interest); this study is included but cannot be directly compared to the other studies that examined food insecurity as the exposure of interest.…”

“…Only three studies [13,15,16] used complete, validated food security scales to measure food insecurity whereas six studies [37,40,41,46,47,53] used modified versions of validated food insecurity scales (i.e. the US Food Security Scale and the Radimer/Cornell Questionnaire) and two studies [50,54] assessed food access with multiple questions that were not from validated scales ( Table 2).…”

“…''food insufficiency,'' ''hunger'') to refer to similar constructs. Measurement of ART adherence also varied; twelve studies used participant self-report, three [47,50,53] used pharmacy records, and four studies [13,40,41,46] used unannounced pill counts to compute the ratio of pills counted relative to pills prescribed. The selfreport assessments ranged from one to multiple questions or assessment by a visual analog scale and also had various recall periods.…”

“…Studies adjusted for different sets of covariates, and most studies controlled for common confounders such as substance abuse, depression, and comorbidities. All thirteen studies that presented adjusted estimates considered confounding by SES in their analyses, with eight studies [15,16,38,40,41,48,50,54] controlling for some measure of SES in their adjusted models (by inclusion of variables such as education, employment, income, household financial situation, and housing conditions). Five papers excluded a measure of SES from the final multivariable model either because it was determined not to be a confounder [42,46,51,52] or because of collinearity with other variables in the model [45].…”