Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care in Uganda.

aFielding School of Public Health, University of California Los Angeles, Los Angeles, CA USA bRAND Corporation, Santa Monica, CA USA cJoint Clinical Research Centre, Kampala, Uganda.
AIDS (London, England) (Impact Factor: 6.56). 08/2012; 26(18). DOI: 10.1097/QAD.0b013e328359b809
Source: PubMed

ABSTRACT OBJECTIVES:: Although the physical health benefits of HIV antiretroviral therapy (ART) are well documented, the socioeconomic benefits are still being established. Few studies have examined the effects of ART on food insecurity, although studies suggest there may be a benefit via improved health and ability to work. DESIGN:: Twelve-month prospective cohort study of 602 treatment-naïve patients initiating clinical care in Uganda. METHODS:: Longitudinal multivariate logistic regression is used to investigate the effect of ART on food insecurity compared to HIV care without ART. A staged regression approach is used to explore pathways through which ART may affect food insecurity. RESULTS:: Food insecurity decreased significantly for both the ART and non-ART groups over time, with the ART group experiencing greater reductions by the end of the study. ART remained a significant predictor of reduction in food insecurity over time after controlling for baseline differences in the regression model (OR = 0.642; p < 0.01). Improvements in work and mental health status were identified as potential pathways through which ART may improve food security. CONCLUSION:: Taken together with the well-known benefits of food security on ART adherence, treatment retention and clinical outcomes in resource-poor settings, our results suggest that a positive feedback loop of improved functioning and productivity could result from the interaction between food security and ART. Policy makers could leverage this positive cycle by strengthening mental health support and promoting sustainable food security interventions as part of HIV treatment programs.

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