Food Access and Diet Quality Are Associated with Quality of Life Outcomes among HIV-Infected Individuals in Uganda

Stony Brook University (SUNY), Program in Public Health/Department of Preventive Medicine, Stony Brook, New York, United States of America.
PLoS ONE (Impact Factor: 3.23). 04/2013; 8(4):e62353. DOI: 10.1371/journal.pone.0062353
Source: PubMed


Food insecurity is associated with poor nutritional and clinical outcomes among people living with HIV/AIDS. Few studies investigate the link between food insecurity, dietary diversity and health-related quality of life among people living with HIV/AIDS.
We investigated whether household food access and individual dietary diversity are associated with health-related quality of life among people living with HIV/AIDS in Uganda.
We surveyed 902 people living with HIV/AIDS and their households from two clinics in Northern Uganda. Health-related quality of life outcomes were assessed using the Medical Outcomes Study (MOS)-HIV Survey. We performed multivariate regressions to investigate the relationship between health-related quality of life, household food insecurity and individual dietary diversity.
People living with HIV/AIDS from severe food insecurity households have mean mental health status scores that are 1.7 points lower (p<.001) and physical health status scores that are 1.5 points lower (p<.01). Individuals with high dietary diversity have mean mental health status scores that were 3.6 points higher (p<.001) and physical health status scores that were 2.8 points higher (p<.05).
Food access and diet quality are associated with health-related quality of life and may be considered as part of comprehensive interventions designed to mitigate psychosocial consequences of HIV.

Download full-text


Available from: Tia M Palermo
  • Source
    • "Quality of life was assessed in the operational research evaluation for this program, and was not found to differ between participant and comparator households [20]. However, other studies have found important linkages between health-related quality of life and food access and diet quality among PLHIV [47]. This important potential benefit of food assistance and nutrition support programs for PLHIV should be further investigated in other settings. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs. This analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey. Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished. Cost outcomes were 20-30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.
    Full-text · Article · Apr 2014 · Cost Effectiveness and Resource Allocation
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although the last decade has seen increased access to anti-retroviral therapy (ART) across the developing world, widespread food insecurity and undernutrition continue to compromise an effective response to the AIDS epidemic. Limited evidence exists on the potential benefit of food security and nutrition interventions to people living with HIV (PLHIV). We capitalized on an existing intervention to PLHIV in Uganda, and conducted a prospective quasi-experimental study evaluating the impact of a monthly household food basket, provided to food insecure ART naïve PLHIVs for 12months. The outcomes of interest, measured at baseline and follow-up, were nutritional status (body mass index (BMI); mid-upper arm circumference (MUAC), and hemoglobin (Hb) concentrations), disease severity (CD4 count), and two measures of food security: diet quality (Individual Dietary Diversity Score (IDDS)) and food access (Household Food Insecurity Access Scale (HFIAS)). We utilized difference-in-difference propensity score matching to examine the impact of food assistance. Over 12 months, food assistance significantly increased BMI by 0.6 kg/m (P< 0.01), and MUAC by 6.7 mm (P<0.05). We found no impact on CD4 count, Hb concentrations, or IDDS. Restricting the analysis to individuals with CD4 counts >350 cells/μL, there were significant impacts on Hb concentrations (1.0 g/dL; P<0.05). At the household level, food assistance increased the HFIAS, by 2.1 points (P<0.01). This study demonstrates the potential for food assistance programming to be part of the standard of care for PLHIV in areas of widespread food insecurity.
    Full-text · Article · Dec 2013 · JAIDS Journal of Acquired Immune Deficiency Syndromes
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The literature on the potential clinical and non-clinical benefits of participation in food assistance programs for people living with HIV in developed countries is scarce. We conducted a cross-sectional study of 165 HIV infected adults to determine the impact of the Supplemental Nutrition Assistance Program (SNAP) on HIV disease status and health related quality of life (HQROL). There was no significant association between SNAP participation and disease status; CD4 cell count (β = 0.02, P = 0.837) and viral load (β = 0.02, P = 0.836). The mean scores for all the HRQOL domains were lower compared to the US population, but none were associated with SNAP participation. Higher scores on the general health domain, were marginally associated with SNAP participation (β = 0.16, P = 0.071). In this study, SNAP participation was not significantly associated with less disease progression, and only marginally associated with quality of life among this population of HIV infected individuals.
    Full-text · Article · May 2014 · AIDS and Behavior
Show more