Household Food Insecurity Associated with Antiretroviral Therapy Adherence Among HIV-infected Patients in Windhoek, Namibia
Identifieur interne : 001D21 ( Main/Exploration ); précédent : 001D20; suivant : 001D22Household Food Insecurity Associated with Antiretroviral Therapy Adherence Among HIV-infected Patients in Windhoek, Namibia
Auteurs : Steven Y. Hong [États-Unis] ; Theresa J. Fanelli [États-Unis] ; Anna Jonas [Namibie] ; Justice Gweshe [États-Unis] ; Francina Tjituka [Namibie] ; Heidi Mb Sheehan [États-Unis] ; Christine Wanke [États-Unis] ; Norma Terrin [États-Unis] ; Michael R. Jordan [États-Unis] ; Alice M. Tang [États-Unis]Source :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2014.
Abstract
Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that utilizes the public health model of delivery.
A cross-sectional study using a one-time questionnaire and routinely collected pharmacy data.
Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence.
Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% (OR 3.84, 1.65 to 8.95). Higher household healthcare spending (OR 1.92, 1.02 to 3.57) and longer duration of ART (OR 0.82, 0.70 to 0.97) were also associated with <80% MPR.
Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia, and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.
Url:
DOI: 10.1097/QAI.0000000000000308
PubMed: 25356779
PubMed Central: 4215168
Affiliations:
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Hong</name><affiliation wicri:level="2"><nlm:aff id="A1">Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="A2">Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Fanelli, Theresa J" sort="Fanelli, Theresa J" uniqKey="Fanelli T" first="Theresa J." last="Fanelli">Theresa J. Fanelli</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Jonas, Anna" sort="Jonas, Anna" uniqKey="Jonas A" first="Anna" last="Jonas">Anna Jonas</name><affiliation wicri:level="1"><nlm:aff id="A3">Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia</nlm:aff><country xml:lang="fr">Namibie</country><wicri:regionArea>Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek</wicri:regionArea><wicri:noRegion>Windhoek</wicri:noRegion></affiliation></author><author><name sortKey="Gweshe, Justice" sort="Gweshe, Justice" uniqKey="Gweshe J" first="Justice" last="Gweshe">Justice Gweshe</name><affiliation wicri:level="2"><nlm:aff id="A4">Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Tjituka, Francina" sort="Tjituka, Francina" uniqKey="Tjituka F" first="Francina" last="Tjituka">Francina Tjituka</name><affiliation wicri:level="1"><nlm:aff id="A3">Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek, Namibia</nlm:aff><country xml:lang="fr">Namibie</country><wicri:regionArea>Directorate of Special Programmes, Republic of Namibia Ministry of Health and Social Services, Windhoek</wicri:regionArea><wicri:noRegion>Windhoek</wicri:noRegion></affiliation></author><author><name sortKey="Sheehan, Heidi Mb" sort="Sheehan, Heidi Mb" uniqKey="Sheehan H" first="Heidi Mb" last="Sheehan">Heidi Mb Sheehan</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Wanke, Christine" sort="Wanke, Christine" uniqKey="Wanke C" first="Christine" last="Wanke">Christine Wanke</name><affiliation wicri:level="2"><nlm:aff id="A1">Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="A2">Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Terrin, Norma" sort="Terrin, Norma" uniqKey="Terrin N" first="Norma" last="Terrin">Norma Terrin</name><affiliation wicri:level="2"><nlm:aff id="A4">Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="A5">Tufts Clinical and Translational Science Institute, Tufts University, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Tufts Clinical and Translational Science Institute, Tufts University, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Jordan, Michael R" sort="Jordan, Michael R" uniqKey="Jordan M" first="Michael R." last="Jordan">Michael R. Jordan</name><affiliation wicri:level="2"><nlm:aff id="A1">Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="A2">Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Tang, Alice M" sort="Tang, Alice M" uniqKey="Tang A" first="Alice M." last="Tang">Alice M. Tang</name><affiliation wicri:level="2"><nlm:aff id="A2">Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts</wicri:regionArea><placeName><region type="state">Massachusetts</region></placeName></affiliation></author></analytic><series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">Food insecurity is emerging as an important barrier to antiretroviral therapy (ART) adherence. The objective of this study was to determine if food insecurity is associated with poor ART adherence among HIV-positive adults in a resource-limited setting that utilizes the public health model of delivery.</p></sec><sec id="S2"><title>Design</title><p id="P2">A cross-sectional study using a one-time questionnaire and routinely collected pharmacy data.</p></sec><sec id="S3"><title>Methods</title><p id="P3">Participants were HIV-infected adults on ART at the public ART clinics in Windhoek, Namibia: Katutura State Hospital, Katutura Health Centre, and Windhoek Central Hospital. Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). Adherence was assessed by the pharmacy adherence measure medication possession ratio (MPR). Multivariate regression was used to assess whether food insecurity was associated with ART adherence.</p></sec><sec id="S4"><title>Results</title><p id="P4">Among 390 participants, 7% were food secure, 25% were mildly or moderately food insecure and 67% were severely food insecure. In adjusted analyses, severe household food insecurity was associated with MPR <80% (OR 3.84, 1.65 to 8.95). Higher household healthcare spending (OR 1.92, 1.02 to 3.57) and longer duration of ART (OR 0.82, 0.70 to 0.97) were also associated with <80% MPR.</p></sec><sec id="S5"><title>Conclusion</title><p id="P5">Severe household food insecurity is present in more than half of the HIV-positive adults attending a public ART clinic in Windhoek, Namibia, and is associated with poor ART adherence as measured by MPR. Ensuring reliable access to food should be an important component of ART delivery in resource-limited settings using the public health model of care.</p></sec></div></front></TEI><affiliations><list><country><li>Namibie</li><li>États-Unis</li></country><region><li>Massachusetts</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Hong, Steven Y" sort="Hong, Steven Y" uniqKey="Hong S" first="Steven Y." last="Hong">Steven Y. Hong</name></region><name sortKey="Fanelli, Theresa J" sort="Fanelli, Theresa J" uniqKey="Fanelli T" first="Theresa J." last="Fanelli">Theresa J. Fanelli</name><name sortKey="Gweshe, Justice" sort="Gweshe, Justice" uniqKey="Gweshe J" first="Justice" last="Gweshe">Justice Gweshe</name><name sortKey="Hong, Steven Y" sort="Hong, Steven Y" uniqKey="Hong S" first="Steven Y." last="Hong">Steven Y. Hong</name><name sortKey="Jordan, Michael R" sort="Jordan, Michael R" uniqKey="Jordan M" first="Michael R." last="Jordan">Michael R. Jordan</name><name sortKey="Jordan, Michael R" sort="Jordan, Michael R" uniqKey="Jordan M" first="Michael R." last="Jordan">Michael R. Jordan</name><name sortKey="Sheehan, Heidi Mb" sort="Sheehan, Heidi Mb" uniqKey="Sheehan H" first="Heidi Mb" last="Sheehan">Heidi Mb Sheehan</name><name sortKey="Tang, Alice M" sort="Tang, Alice M" uniqKey="Tang A" first="Alice M." last="Tang">Alice M. Tang</name><name sortKey="Terrin, Norma" sort="Terrin, Norma" uniqKey="Terrin N" first="Norma" last="Terrin">Norma Terrin</name><name sortKey="Terrin, Norma" sort="Terrin, Norma" uniqKey="Terrin N" first="Norma" last="Terrin">Norma Terrin</name><name sortKey="Wanke, Christine" sort="Wanke, Christine" uniqKey="Wanke C" first="Christine" last="Wanke">Christine Wanke</name><name sortKey="Wanke, Christine" sort="Wanke, Christine" uniqKey="Wanke C" first="Christine" last="Wanke">Christine Wanke</name></country><country name="Namibie"><noRegion><name sortKey="Jonas, Anna" sort="Jonas, Anna" uniqKey="Jonas A" first="Anna" last="Jonas">Anna Jonas</name></noRegion><name sortKey="Tjituka, Francina" sort="Tjituka, Francina" uniqKey="Tjituka F" first="Francina" last="Tjituka">Francina Tjituka</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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