Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV

Abstract

Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women's Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.

The impact of food insecurity on receipt of care, retention in care, and viral suppression among people living with HIV/AIDS in the United States: a causal mediation analysis

“…Optimal ART adherence was the primary mediator investigated for viral non-suppression. Our findings are consistent with previous work illustrating the relationship between food insecurity and worse HIV outcomes (14,16,19,20,33,46). However, the prevalence of food insecurity among PLWHA in our sample was greater than other studies (16,19,47), with approximately 78% reporting very low food security and nearly 95% of our sample reporting any food insecurity.…”

“…Mental health and behavioral mechanisms accounted for 15% and 17% of the total effect of food insecurity on CD4 cell count ( 16 ). While previous work has assessed paths between food insecurity and HIV clinical outcomes, including viral suppression, CD4 cell count, and physical health status ( 10 , 16 ), few studies have examined the effects of food insecurity on HIV care continuum outcomes ( 33 ) and relevant biopsychosocial pathways. Given previous qualitative work has illustrated the impact of behavioral, mental health, and nutritional mechanisms on engagement in HIV care ( 34 , 35 ), knowledge of the associations between food insecurity and care continuum outcomes and how intervenable behavioral, mental health, and nutritional mechanisms may influence these relationships will allow researchers to develop strategic interventions that target specific pathways based on the intended outcome.…”

Perfil alimentar e sintomas de pessoas vivendo com HIV/AIDS residentes na cidade de Ponta Grossa/PR

“…No entanto, apesar dessas medidas, as pessoas com HIV ainda enfrentam insegurança alimentar de forma desproporcional em comparação com a população em geral. Reconhecendo os impactos negativos da insegurança alimentar na saúde dos portadores de HIV, incluindo entre as mulheres, há uma crescente atenção política voltada para abordar esse problema tanto na comunidade quanto nos ambientes de saúde (Palar et al, 2023). Isso ressalta a importância vital e urgente de implementar políticas públicas que garantam a segurança alimentar e nutricional desses cidadãos.…”