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The Impact of a Community-Based Intervention Including a Monthly Food Ration on Food Insecurity Among HIV-Positive Adults During the First Year of Antiretroviral Therapy

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Abstract

The objective of this study was to examine how food insecurity changed among HIV-positive adults during the first 12 months of combination antiretroviral therapy (cART) and whether any change differed according to the receipt of food support, which was provided in the context of a comprehensive community-based intervention. We conducted secondary data analyses of data from a prospective cohort study of the effectiveness of a community-based cART delivery model when added to clinic-based cART delivery in Rwanda. We included patients from four health centers that implemented a clinic-based cART delivery model alone and five health centers that additionally implemented the intervention, which included 10 months of food support. We compared food insecurity at 3, 6, and 12 months, relative to baseline, and stratified by receipt of the intervention. Relative to baseline, median food insecurity score decreased after 3, 6, and 12 months (p value <0.0001 for all) for patients receiving a food ration through the community-based model for cART delivery. Among patients receiving care under the clinic-based cART model, food insecurity scores remained unchanged at 3 and 12 months and were significantly higher after 6 months. In adjusted analyses, participants enrolled in the community-based intervention with a food ration had a lower risk of severe food insecurity and a lower risk of moderate or severe food insecurity after 12 months. A comprehensive community-based HIV program including a food ration likely contributes to an alleviation of food insecurity among adults newly initiating cART.

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References

  1. Swindale A, Bilinsky P. Development of a universally applicable household food insecurity measurement tool: process, current status, and outstanding issues. J Nutr. 2006;136(5):1449S–52S.

    CAS  PubMed  Google Scholar 

  2. Tiyou A, Belachew T, Alemseged F, Biadgilign S. Food insecurity and associated factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia. Nutr J. 2012;11(51):1–8.

    Google Scholar 

  3. Panagides D, Graciano R, Atekyereza P, Gerberg L. A review of nutrition and food security approaches in HIV and AIDS programmes in Eastern and Southern Africa. Equinet Discussion Paper Number 48. 2007.

  4. Franke MF, Murray MB, Munoz M, Hernandez-Diaz S, Sebastian JL, Atwood S, et al. Food insufficiency is a risk factor for suboptimal antiretroviral therapy adherence among HIV-infected adults in Urban Peru. AIDS Behav. 2010;15(7):1438–89.

    Google Scholar 

  5. Weiser SD, Palar K, Frongillo EA, Tsai AC, Kumbakumba E, Depee S, et al. Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS. 2014;28(1):115–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Weiser SD, Tuller DM, Frongillo EA, Senkungu J, Mukiibi N, Bangsberg DR. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PLoS ONE. 2010;5(4):1–8.

    Article  Google Scholar 

  7. Singer A, Weiser SD, McCoy S. Does food insecurity undermine adherence to antiretroviral therapy? A systematic review. AIDS Behav. 2015;19(8):1510–26.

    Article  PubMed  Google Scholar 

  8. Weiser SD, Frongillo EA, Ragland K, Hogg RS, Riley ED, Bangsberg DR. Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. J Gen Intern Med. 2009;24(1):14–20.

    Article  PubMed  Google Scholar 

  9. Weiser SD, Fernandes KA, Brandson EK, Lima VD, Anema A, Bangsberg DR, et al. The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr. 2009;52(3):342–9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. McMahon JH, Wanke CA, Elliott JH, Skinner S, Tang AM. Repeated assessments of food security predict CD4 change in the setting of antiretroviral therapy. J Acquir Immune Defic Syndr. 2011;58(1):60–3.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Normen L, Chan K, Braitstein P, Anema A, Bondy G, Montaner JS, et al. Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. J Nutr. 2005;135(4):820–5.

    CAS  PubMed  Google Scholar 

  12. Ivers LC, Cullen KA, Freedberg KA, Block S, Coates J, Webb P. HIV/AIDS, undernutrition, and food insecurity. Clin Infect Dis. 2009;49(7):1096–102.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Palar K, Wagner G, Ghosh-Dastidar B, Mugyenyi P. Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care in Uganda. AIDS. 2012;26(18):2375–81.

    Article  CAS  PubMed  Google Scholar 

  14. Rebick GW, Franke MF, Teng JE, Gregory Jerome J, Ivers LC. Food insecurity, dietary diversity, and body mass index of HIV-infected individuals on antiretroviral therapy in rural Haiti. AIDS Behav. 2015;20(5):1116–22.

    Article  Google Scholar 

  15. Weiser SD, Gupta R, Tsai AC, Frongillo EA, Kumbakumba E, Kawuma A, et al. Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda. J Acquir Immune Defic Syndr. 2012;61(2):179–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Nagata JM, Magerenge RO, Young SL, Oguta JO, Weiser SD, Cohen CR. Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria, Kenya. AIDS Care. 2012;24(6):728–36.

    Article  PubMed  Google Scholar 

  17. Ivers LC, Chang Y, Gregory Jerome J, Freedberg KA. Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study. AIDS Res Ther. 2010;7(33):1–8.

    Google Scholar 

  18. Rehman AM, Woodd S, Chisenga M, Siame J, Sampson G, PrayGod G, et al. Appetite testing in HIV-infected African adults recovering from malnutrition and given antiretroviral therapy. Public Health Nutr. 2015;18(4):742–51.

    Article  PubMed  Google Scholar 

  19. Kelly A, Mek A, Frankland A, Akunai F, Kepa B, Kupul M, et al. Moresby food isn’t good: food security, nutritional information and adherence to antiretroviral therapy in Papua New Guinea. P N G Med J. 2011;54(1–2):23–34.

    CAS  PubMed  Google Scholar 

  20. Tirivayi N, Koethe JR, Groot W. Clinic-based food assistance is associated with increased medication adherence among HIV-infected adults on long-term antiretroviral therapy in Zambia. J AIDS Clin Res. 2012;3(7):1–17.

    Article  Google Scholar 

  21. Ndirangu M, Sziam K, Sheriff M, Hawken M, Arpadi S, Rashid J, et al. Perceptions of food-insecure HIV-positive adults participating in a food supplementation program in central Kenya. J Health Care Poor Underserved. 2014;25(4):1763–83.

    Article  PubMed  Google Scholar 

  22. World Health Organization. Nutrient requirements for people living with HIV/AIDS. Geneva: WHO; 2003.

    Google Scholar 

  23. Un AIDS. Food and nutrition. Geneva: UN AIDS; 2015. p. 1–16.

    Google Scholar 

  24. World Food Programme HIV and AIDS Policy. World Food Programme; 2000.

  25. Chan M. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: World Health Organization; 2013. p. 1–272.

    Google Scholar 

  26. Aberman N-L, Rawat R, Drimie S, Claros JM, Kadiyala S. Food security and nutrition interventions in response to the AIDS epidemic: assessing global action and evidence. AIDS Behav. 2014;18(5):554–65.

    Article  Google Scholar 

  27. Rwanda: Economic Development and Poverty Reduction Strategy 2013–2018. Washington D.C.: International Monetary Fund; 2013. p. 1–141.

  28. International Fund for Agricultural Developmen. Rural Poverty in Rwanda [Internet]. Rural Poverty Portal. 2014. http://www.ruralpovertyportal.org/web/rural-poverty-portal/country/home/tags/rwanda.

  29. Binagwaho A. National guidelines for comprehensive care of people living with HIV in Rwanda. Kigali: Republic of Rwanda Ministry of Health; 2011. p. 1–113.

    Google Scholar 

  30. Binagwaho A. Rwanda HIV and AIDS national strategic plan. Kigali: Republic of Rwanda Ministry of Health; 2013. p. 1–118.

    Google Scholar 

  31. Rich ML, Miller AC, Niyigena P, Franke MF, Niyonzima JB, Socci A, et al. Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda. J Acquir Immune Defic Syndr. 2012;59(3):e35–42.

    Article  PubMed  Google Scholar 

  32. Franke MF, Kaigamba F, Socci AR, Hakizamungu M, Patel A, Bagiruwigize E, et al. Improved retention associated with community-based accompaniment for antiretroviral therapy delivery in rural Rwanda. Clin Infect Dis. 2013;56(9):1319–26.

    Article  CAS  PubMed  Google Scholar 

  33. Thomson D, Rich M, Kaigamba F, Socci A, Hakizamungu M, Bagiruwigize E, et al. Community-based accompaniment and psychosocial health outcomes in HIV-infected adults in Rwanda: a prospective study. AIDS Behav. 2014;18(2):368–80.

    Article  PubMed  Google Scholar 

  34. Knueppel D, Demment M, Kaiser L. Validation of the household food insecurity access scale in rural Tanzania. Public Health Nutr. 2010;13(03):360–7.

    Article  PubMed  Google Scholar 

  35. Hong SY, Fanelli TJ, Jonas A, Gweshe J, Tjituka F, Sheehan HMB, et al. Household food insecurity associated with antiretroviral therapy adherence among HIV-infected patients in Windhoek, Namibia. J Acquir Immune Defic Syndr. 2014;67(4):e115–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Musumari PM, Wouters E, Kayembe PK, Kiumbu Nzita M, Mbikayi SM, Suguimoto SP, et al. Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study. PLoS ONE. 2014;9(1):e85327.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Kadiyala S, Rawat R. Food access and diet quality independently predict nutritional status among people living with HIV in Uganda. Public Health Nutr. 2013;16(01):164–70.

    Article  PubMed  Google Scholar 

  38. Coates J. Household food insecurity access scale (HFIAS) for Measurement of food access: indicator guide. 2007;3(August). p. 1–32.

  39. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Cori L. The hopkins symptom checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19(1):1–15.

    Article  CAS  PubMed  Google Scholar 

  40. Wu AW, Revicki DA, Jacobson D, Malitz FE. Evidence for reliability, validity and usefulness of the medical outcomes study HIV health survey (MOS-HIV). Qual Life Res. 1997;6(6):481–93.

    Article  CAS  PubMed  Google Scholar 

  41. Broadhead WE, Gehlbach SH, de Gury FV, Gruy FV, Kaplan BH. The Duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Med Care. 1988;26(7):709–23.

    Article  CAS  PubMed  Google Scholar 

  42. Epino HM, Rich ML, Kaigamba F, Hakizamungu M, Socci AR, Bagiruwigize E, et al. Reliability and construct validity of three health-related self-report scales in HIV-positive adults in rural Rwanda. AIDS Care. 2012;24(12):1576–83.

    Article  PubMed  Google Scholar 

  43. VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the E-value. Ann Intern Med. 2017;167:268–74.

    Article  PubMed  Google Scholar 

  44. Vinck P. Rwanda comprehensive food security and vulnerability analysis (CFSVA). Kigali: MINECOFIN; 2006.

    Google Scholar 

  45. Cantrell RA, Sinkala M, Megazinni K, Lawson-Marriott S, Washington S, Chi BH, et al. A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr. 2008;49(2):190–5.

    Article  PubMed  Google Scholar 

  46. Ndekha MJ, van Oosterhout JJG, Zijlstra EE, Manary M, Saloojee H, Manary MJ. Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded, controlled trial. BMJ. 2009;338:1–8.

    Article  Google Scholar 

  47. Palar K, Derose KP, Linnemayr S, Smith A, Farias H, Wagner G, et al. Impact of food support on food security and body weight among HIV antiretroviral therapy recipients in Honduras: a pilot intervention trial. AIDS Care. 2015;27(4):409–15.

    Article  PubMed  Google Scholar 

  48. National Institute of Statistics of Rwanda. Rwanda demographic and health survey. Kigali; 2012. p. 411.

  49. Gupta N, Munyaburanga C, Mutagoma M, Niyigena JW, Kayigamba F, Franke MF, et al. Community-based accompaniment mitigates predictors of negative outcomes for adults on antiretroviral therapy in Rural Rwanda. AIDS Behav. 2016;20(5):1009–16.

    Article  PubMed  Google Scholar 

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Acknowledgements

We are grateful to the study staff: Wellars Ndayambaje, Eline Uwitonze, Albertine Mukeshimana, Ernest Nyirinkindi, Jean Damascene Uwamuhoro, Carine Dusenge, Claire Dusabe, and Jean Claude Nyiramana. We also thank Cheryl Amoroso, Benjamin Akimana, Christian Allen, Darius Jazayeri, Ellen Ball, the Rwanda-based Partners In Health–Electronic Medical Record team, and Laboratory Management of the Rwanda National Reference Laboratory.

Author Contributions

JR and MF formulated the research question; MF and FK designed the study, JR, VH, MF analysed the data; NG, JR, MF interpreted the data; JR and MF wrote the first draft, NG critically reviewed the manuscript; all authors reviewed and approved the manuscript.

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Authors and Affiliations

  1. American University, Washington, DC, USA

    Jessica Rothman

  2. Ruhengeri Hospital, Republic of Rwanda Ministry of Health, Kigali, Rwanda

    Felix Kayigamba

  3. Analysis Group Inc, Boston, MA, USA

    Victoria Hills

  4. Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA

    Neil Gupta

  5. HIV, AIDS, STIs and OBBI Division, Rwanda Biomedical Center, Kigali, Rwanda

    Faustin Machara

  6. Community Health Department, Inshuti Mu Buzima/Partners In Health, Rwinkwavu, Rwanda

    Peter Niyigena

  7. Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA

    Molly F. Franke

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  1. Jessica Rothman
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Correspondence to Molly F. Franke.

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Conflict of interest

This work was supported by the Doris Duke Charitable Foundation through their Operational Research for AIDS Care and Treatment in Africa program. The authors declare no-conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Partners Human Research Committee and the Rwanda National Ethics Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

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Rothman, J., Kayigamba, F., Hills, V. et al. The Impact of a Community-Based Intervention Including a Monthly Food Ration on Food Insecurity Among HIV-Positive Adults During the First Year of Antiretroviral Therapy. AIDS Behav 22, 154–163 (2018). https://doi.org/10.1007/s10461-017-1897-0

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  • DOI: https://doi.org/10.1007/s10461-017-1897-0

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