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: 5.55).
08/2012; 26(18). DOI: 10.1097/QAD.0b013e328359b809
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.
Available from: Abigail Hatcher
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ABSTRACT: Depression is associated with increased HIV transmission risk, increased morbidity, and higher risk of HIV-related death among HIV-infected women. Low sexual relationship power also contributes to HIV risk, but there is limited understanding of how it relates to mental health among HIV-infected women.
Participants were 270 HIV-infected women from the Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of individuals initiating antiretroviral therapy (ART) in Mbarara, Uganda. Our primary predictor was baseline sexual relationship power as measured by the Sexual Relationship Power Scale (SRPS). The primary outcome was depression severity, measured with the Hopkins Symptom Checklist (HSCL), and a secondary outcome was a functional scale for mental health status (MHS). Adjusted models controlled for socio-demographic factors, CD4 count, alcohol and tobacco use, baseline WHO stage 4 disease, social support, and duration of ART.
The mean HSCL score was 1.34 and 23.7% of participants had HSCL scores consistent with probable depression (HSCL>1.75). Compared to participants with low SRPS scores, individuals with both moderate (coefficient b = -0.21; 95%CI, -0.36 to -0.07) and high power (b = -0.21; 95%CI, -0.36 to -0.06) reported decreased depressive symptomology. High SRPS scores halved the likelihood of women meeting criteria for probable depression (adjusted odds ratio = 0.44; 95%CI, 0.20 to 0.93). In lagged models, low SRPS predicted subsequent depression severity, but depression did not predict subsequent changes in SPRS. Results were similar for MHS, with lagged models showing SRPS predicts subsequent mental health, but not visa versa. Both Decision-Making Dominance and Relationship Control subscales of SRPS were associated with depression symptom severity.
HIV-infected women with high sexual relationship power had lower depression and higher mental health status than women with low power. Interventions to improve equity in decision-making and control within dyadic partnerships are critical to prevent HIV transmission and to optimize mental health of HIV-infected women.
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ABSTRACT: Program implementers and qualitative researchers have described how increasing availability of HIV antiretroviral therapy (ART) is associated with improvements in psychosocial health and internalized stigma. To determine whether, and through what channels, ART reduces internalized stigma, we analyzed data from 262 HIV-infected, treatment-naïve persons in rural Uganda followed from ART initiation over a median of 3.4 years. We fitted Poisson regression models with cluster-correlated robust estimates of variance, specifying internalized stigma as the dependent variable, adjusting for time on treatment as well as socio-demographic, clinical, and psychosocial variables. Over time on treatment, internalized stigma declined steadily, with the largest decline observed during the first 2 years of treatment. This trend remained statistically significant after multivariable adjustment (χ(2) = 28.3; P = 0.03), and appeared to be driven by ART-induced improvements in HIV symptom burden, physical and psychological wellbeing, and depression symptom severity.
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ABSTRACT: A growing body of research has identified food insecurity as a barrier to antiretroviral therapy (ART) adherence. We systematically reviewed and summarized the quantitative literature on food insecurity or food assistance and ART adherence. We identified nineteen analyses from eighteen distinct studies examining food insecurity and ART adherence. Of the thirteen studies that presented an adjusted effect estimate for the relationship between food insecurity and ART adherence, nine found a statistically significant association between food insecurity and sub-optimal ART adherence. Four studies examined the association between food assistance and ART adherence, and three found that ART adherence was significantly better among food assistance recipients than non-recipients. Across diverse populations, food insecurity is an important barrier to ART adherence, and food assistance appears to be a promising intervention strategy to improve ART adherence among persons living with HIV. Additional research is needed to determine the effectiveness and cost-effectiveness of food assistance in improving ART adherence and other clinical outcomes among people living with HIV in the era of widespread and long-term treatment.
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