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Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV

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Abstract

Food insecurity disproportionately affects people with HIV and women in the United States (US). More evidence is needed to understand the interplay between levels of food insecurity and levels of antiretroviral therapy (ART) adherence over time, as well as how food insecurity relates to engagement in HIV care. We used random effects models with longitudinal data from the US Women’s Interagency HIV Study to estimate the (1) adjusted associations of current and 6-month lagged food security with ART adherence categories (n = 1646), and (2) adjusted associations of food security with engagement-in-care (n = 1733). Very low food security was associated with a higher relative risk of ART non-adherence at prior and current visits compared with food security, and this association increased across non-adherence categories. Very low food security was associated with lower odds of receiving HIV care and higher odds of a missed visit. Food insecurity among US women with HIV is associated with poorer engagement in care and degree of ART non-adherence over time.

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Data availability

Access to individual-level data from the MACS/WIHS Combined Cohort Study Data (MWCCS) may be obtained upon review and approval of a MWCCS concept sheet. Links and instructions for online concept sheet submission are on the study website: https://statepi.jhsph.edu/mwccs/work-with-us/

Code Availability

Stata 14 (Stata Corp., College Station, TX, USA) was used for all analyses. Study code has been shared with the main MACS/WIHS Combined Cohort Study Data Center. We are willing to share our study code upon request.

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Acknowledgements

The authors gratefully acknowledge the contributions of the study participants and dedication of the staff at the MWCCS sites.

Funding

Data in this manuscript were collected by the Women’s Interagency HIV Study (WIHS), now the MACS/WIHS Combined Cohort Study (MWCCS), and funded by a grant from the National Institute of Mental Health, R01MH095683 (Weiser). Additional salary support was provided by K01DK107335 (Palar). The contents of this publication are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIH). MWCCS (Principal Investigators): Atlanta CRS (Ighovwerha Ofotokun, Anandi Sheth, and Gina Wingood), U01-HL146241; Baltimore CRS (Todd Brown and Joseph Margolick), U01-HL146201; Bronx CRS (Kathryn Anastos, David Hanna, and Anjali Sharma), U01-HL146204; Brooklyn CRS (Deborah Gustafson and Tracey Wilson), U01-HL146202; Data Analysis and Coordination Center (Gypsyamber D’Souza, Stephen Gange and Elizabeth Topper), U01-HL146193; Chicago-Cook County CRS (Mardge Cohen and Audrey French), U01-HL146245; Chicago-Northwestern CRS (Steven Wolinsky), U01-HL146240; Northern California CRS (Bradley Aouizerat, Jennifer Price, and Phyllis Tien), U01-HL146242; Los Angeles CRS (Roger Detels and Matthew Mimiaga), U01-HL146333; Metropolitan Washington CRS (Seble Kassaye and Daniel Merenstein), U01-HL146205; Miami CRS (Maria Alcaide, Margaret Fischl, and Deborah Jones), U01-HL146203; Pittsburgh CRS (Jeremy Martinson and Charles Rinaldo), U01-HL146208; UAB-MS CRS (Mirjam-Colette Kempf, Jodie Dionne-Odom, and Deborah Konkle-Parker), U01-HL146192; UNC CRS (Adaora Adimora and Michelle Floris-Moore), U01-HL146194. The MWCCS is funded primarily by the National Heart, Lung, and Blood Institute (NHLBI), with additional co-funding from the Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Institute On Aging (NIA), National Institute Of Dental & Craniofacial Research (NIDCR), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Neurological Disorders And Stroke (NINDS), National Institute Of Mental Health (NIMH), National Institute On Drug Abuse (NIDA), National Institute Of Nursing Research (NINR), National Cancer Institute (NCI), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Deafness and Other Communication Disorders (NIDCD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute on Minority Health and Health Disparities (NIMHD), and in coordination and alignment with the research priorities of the National Institutes of Health, Office of AIDS Research (OAR). MWCCS data collection is also supported by UL1-TR000004 (UCSF CTSA), UL1-TR003098 (JHU ICTR), UL1-TR001881 (UCLA CTSI), P30-AI-050409 (Atlanta CFAR), P30-AI-073961 (Miami CFAR), P30-AI-050410 (UNC CFAR), P30-AI-027767 (UAB CFAR), P30-MH-116867 (Miami CHARM), UL1-TR001409 (DC CTSA), KL2-TR001432 (DC CTSA), and TL1-TR001431 (DC CTSA).

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Authors and Affiliations

  1. Division of HIV, ID and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA

    Kartika Palar, Lila A. Sheira & Sheri D. Weiser

  2. Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA

    Edward A. Frongillo

  3. Division of General Internal Medicine at San Francisco General Hospital, UCSF, San Francisco, CA, USA

    Margot Kushel

  4. Department of Community Health Sciences, State University of New York Downstate Health Sciences University, School of Public Health, Brooklyn, NY, USA

    Tracey E. Wilson

  5. Department of Medicine, Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA

    Amy A. Conroy & Sheri D. Weiser

  6. Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA

    Adebola Adedimeji

  7. Department of Family Medicine, Georgetown University Medical Center, Washington, DC, USA

    Daniel Merenstein

  8. Department of Medicine, Stroger Hospital, Chicago, IL, USA

    Mardge H. Cohen

  9. Bloomberg School of Public Health, Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA

    Eryka L. Wentz

  10. School of Medicine and UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Adaora A. Adimora

  11. School of Medicine, Emory University, Atlanta, GA, USA

    Ighovwerha Ofotokun

  12. Grady Healthcare System, Atlanta, GA, USA

    Ighovwerha Ofotokun

  13. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA

    Lisa R. Metsch

  14. Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Janet M. Turan

  15. Department of Medicine, University of California, San Francisco, CA, USA

    Phyllis C. Tien

  16. Medical Service, Department of Veteran Affairs Medical Center, San Francisco, USA

    Phyllis C. Tien

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  1. Kartika Palar
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  2. Lila A. Sheira
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  3. Edward A. Frongillo
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  4. Margot Kushel
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  8. Daniel Merenstein
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  11. Adaora A. Adimora
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  12. Ighovwerha Ofotokun
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  15. Phyllis C. Tien
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  16. Sheri D. Weiser
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Contributions

SDW, KP, PT, MK and EAF conceived of the work. SDW, KP, EAF, LS and KP designed the work. KP wrote the manuscript. TEW, AC, AA, DM, MHC, ELW, AAA, IO, LM, JMT, and PCT contributed to acquisition of the data. LAS and EAF performed statistical analyses. SDW, LAS, EAF, TEW, AC, AA, DM, MHC, ELW, AAA, IO, LM, JMT, and PCT contributed to the interpretation of data for the work and made critical revisions to the work for important intellectual content.

Corresponding author

Correspondence to Kartika Palar.

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The authors declare that they have no competing interests.

Ethical Approval

This study was approved by the Institutional Review Board at each study site’s institution and by the WIHS Executive Committee.

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Written informed consent was obtained for all participants in the study.

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Written informed consent obtained for the study included publication of the results, with the assurance that no individually identifiable data would be included in publications.

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Palar, K., Sheira, L.A., Frongillo, E.A. et al. Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV. AIDS Behav 27, 3345–3355 (2023). https://doi.org/10.1007/s10461-023-04053-9

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