AIDS and Behavior

, Volume 19, Issue 8, pp 1510–1526 | Cite as

Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review

  • Amanda W. Singer
  • Sheri D. Weiser
  • Sandra I. McCoy
Substantive Review

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.

Keywords

Food insecurity Food assistance Antiretroviral therapy Adherence Review 

References

  1. 1.
    Bangsberg DR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Maggiolo F, et al. Similar adherence rates favor different virologic outcomes for patients treated with nonnucleoside analogues or protease inhibitors. Clin Infect Dis. 2005;40(1):158–63.PubMedCrossRefGoogle Scholar
  3. 3.
    Sungkanuparph S, et al. Rapid CD4 decline after interruption of non-nucleoside reverse transcriptase inhibitor-based antiretroviral therapy in a resource-limited setting. AIDS Res Ther. 2007;4:26.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Kiwuwa-Muyingo S, et al. The impact of first year adherence to antiretroviral therapy on long-term clinical and immunological outcomes in the DART trial in Uganda and Zimbabwe. Trop Med Int Health. 2012;17(5):584–94.PubMedCrossRefGoogle Scholar
  5. 5.
    Cohen MS, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Mills EJ, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679–90.PubMedCrossRefGoogle Scholar
  7. 7.
    WHO. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. Geneva: WHO; 2013.Google Scholar
  8. 8.
    Nagata JM, et al. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Goudge J, Ngoma B. Exploring antiretroviral treatment adherence in an urban setting in South Africa. J Public Health Policy. 2011;32(Suppl 1):S52–64.PubMedCrossRefGoogle Scholar
  10. 10.
    Weiser SD, et al. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PLoS ONE. 2010;5(4):e10340.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    AO F. Rome declaration on world food security. Rome: Food and Agriculture Organization; 1996.Google Scholar
  12. 12.
    Frega R, et al. Food insecurity in the context of HIV/AIDS: a framework for a new era of programming. Food Nutr Bull. 2010;31(4):S292–312.Google Scholar
  13. 13.
    Weiser SD, et al. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Wang EA, et al. Food insecurity is associated with poor virologic response among HIV-infected patients receiving antiretroviral medications. J Gen Intern Med. 2011;26(9):1012–8.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Weiser SD, et al. Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS. 2014;28(1):115–20.Google Scholar
  16. 16.
    Weiser SD, et al. Food insecurity and HIV clinical outcomes in a longitudinal study of homeless and marginally housed HIV-infected individuals in San Francisco. AIDS. 2013;27(18):2953–8.Google Scholar
  17. 17.
    McMahon JH, et al. Repeated assessments of food security predict CD4 change in the setting of antiretroviral therapy. J Acquir Immune Defic Syndr. 2011;58(1):60–3.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Normen L, et al. Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. J Nutr. 2005;135(4):820–5.PubMedGoogle Scholar
  19. 19.
    Weiser SD, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012;26(1):67–75.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Weiser SD, 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.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Weiser SD, et al. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr. 2011;94(6):1729S–39S.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Cantrell RA, 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.PubMedCrossRefGoogle Scholar
  23. 23.
    Ivers LC, et al. 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.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Sztam KA, Fawzi WW, Duggan C. Macronutrient supplementation and food prices in HIV treatment. J Nutr. 2010;140(1):213S–23S.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Anema A, et al. Availability of nutritional support services in HIV care and treatment sites in sub-Saharan African countries. Public Health Nutr. 2012;15(5):938–47.PubMedCrossRefGoogle Scholar
  26. 26.
    Lamb MR, et al. Association of adherence support and outreach services with total attrition, loss to follow-up, and death among ART patients in sub-Saharan Africa. PLoS ONE. 2012;7(6):e38443.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Forrester JE, Sztam KA. Micronutrients in HIV/AIDS: is there evidence to change the WHO 2003 recommendations? Am J Clin Nutr. 2011;94(6):1683S–9S.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Ndekha M, et al. Nutritional status of Malawian adults on antiretroviral therapy 1 year after supplementary feeding in the first 3 months of therapy. Trop Med Int Health. 2009;14(9):1059–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Ndekha MJ, et al. 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:b1867.PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Kabore I, et al. The effect of community-based support services on clinical efficacy and health-related quality of life in HIV/AIDS patients in resource-limited settings in sub-Saharan Africa. AIDS Patient Care STDS. 2010;24(9):581–94.PubMedCrossRefGoogle Scholar
  31. 31.
    Franke MF, et al. Improved Retention Associated With Community-Based Accompaniment for Antiretroviral Therapy Delivery in Rural Rwanda. Clin Infect Dis. 2013;56(9):1319–26.PubMedCrossRefGoogle Scholar
  32. 32.
    Nyamathi A, et al. Impact of a rural village women (Asha) intervention on adherence to antiretroviral therapy in southern India. Nurs Res. 2012;61(5):353–62.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    Talisuna-Alamo S, et al. Socioeconomic support reduces nonretention in a comprehensive, community-based antiretroviral therapy program in Uganda. J Acquir Immune Defic Syndr. 2012;59(4):e52–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Biadgilign S, et al. Adherence to highly active antiretroviral therapy and its correlates among HIV infected pediatric patients in Ethiopia. BMC Pediatr. 2008;8:53.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Stroup DF, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008–12.PubMedCrossRefGoogle Scholar
  36. 36.
    StataCorp. Stata statistical software: Release 12, 2011, StataCorp LP: College Station, TX.Google Scholar
  37. 37.
    Anema A, et al. High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting. AIDS Care. 2011;23(2):221–30.PubMedCrossRefGoogle Scholar
  38. 38.
    Peretti-Watel P, et al. Vulnerability, unsafe sex and non-adherence to HAART: evidence from a large sample of French HIV/AIDS outpatients. Soc Sci Med. 2006;62(10):2420–33.PubMedCrossRefGoogle Scholar
  39. 39.
    Young S, et al. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav. 2013. doi:10.1007/s10461-013-0547-4.
  40. 40.
    Kalichman SC, et al. Health and treatment implications of food insufficiency among people living with HIV/AIDS, Atlanta, Georgia. J Urban Health. 2010;87(4):631–41.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Kalichman SC, et al. Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. Prev Sci. 2011;12(3):324–32.PubMedCrossRefGoogle Scholar
  42. 42.
    Boyer S, et al. Non-adherence to antiretroviral treatment and unplanned treatment interruption among people living with HIV/AIDS in Cameroon: individual and healthcare supply-related factors. Soc Sci Med. 2011;72(8):1383–92.PubMedCrossRefGoogle Scholar
  43. 43.
    Marcellin F, et al. Determinants of unplanned antiretroviral treatment interruptions among people living with HIV in Yaounde, Cameroon (EVAL survey, ANRS 12-116). Trop Med Int Health. 2008;13(12):1470–8.PubMedCrossRefGoogle Scholar
  44. 44.
    Posse M, et al. The effect of food assistance on adherence to antiretroviral therapy among HIV/AIDS patients in Sofala Province, in Mozambique: a retrospective study. J AIDS Clin Res. 2013;4(3):1000198. doi:10.4172/2155-6113.1000198.
  45. 45.
    Gebo KA, Keruly J, Moore RD. Association of social stress, illicit drug use, and health beliefs with nonadherence to antiretroviral therapy. J Gen Intern Med. 2003;18(2):104–11.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Kalichman SC, Grebler T. Stress and poverty predictors of treatment adherence among people with low-literacy living with HIV/AIDS. Psychosom Med. 2010;72(8):810–6.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Anema A, et al. Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada. PLoS ONE. 2013;8(5):e61277.Google Scholar
  48. 48.
    Kelly A, 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.PubMedGoogle Scholar
  49. 49.
    Van Dyk AC. Treatment adherence following national antiretroviral rollout in South Africa. Ajar-Afr J Aids Res. 2010;9(3):235–47.CrossRefGoogle Scholar
  50. 50.
    Birbeck GL, et al. Neuropsychiatric and socioeconomic status impact antiretroviral adherence and mortality in rural Zambia. Am J Trop Med Hyg. 2011;85(4):782–9.PubMedCentralPubMedCrossRefGoogle Scholar
  51. 51.
    Franke MF, et al. Food insufficiency is a risk factor for suboptimal antiretroviral therapy adherence among HIV-infected adults in urban Peru. AIDS Behav. 2011;15(7):1483–9.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Sasaki Y, et al. Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients. Ann Clin Microbiol Antimicrob. 2012;11:34.PubMedCentralPubMedCrossRefGoogle Scholar
  53. 53.
    Parashar S, et al. Sticking to it: the effect of maximally assisted therapy on antiretroviral treatment adherence among individuals living with HIV who are unstably housed. AIDS Behav. 2011;15(8):1612–22.PubMedCrossRefGoogle Scholar
  54. 54.
    Berhe N, Tegabu D, Alemayehu M. Effect of nutritional factors on adherence to antiretroviral therapy among HIV-infected adults: a case control study in Northern Ethiopia. BMC Infect Dis. 2013;13:233.PubMedCentralPubMedCrossRefGoogle Scholar
  55. 55.
    Sterne JAC, Harbord RM. Funnel plots in meta-analysis. Stata J. 2004;4(2):127–41.Google Scholar
  56. 56.
    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):171.PubMedCentralPubMedCrossRefGoogle Scholar
  57. 57.
    Serrano C, et al. Family nutritional support improves survival, immune restoration and adherence in HIV patients receiving ART in developing country. Asia Pac J Clin Nutr. 2010;19(1):68–75.PubMedGoogle Scholar
  58. 58.
    Chesney MA. Factors affecting adherence to antiretroviral therapy. Clin Infect Dis. 2000;30(Suppl 2):S171–6.PubMedCrossRefGoogle Scholar
  59. 59.
    Spire B, et al. Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach. Soc Sci Med. 2002;54(10):1481–96.PubMedCrossRefGoogle Scholar
  60. 60.
    Gutierrez EB, et al. Measuring adherence to antiretroviral treatment: the role of pharmacy records of drug withdrawals. AIDS Behav. 2012;16(6):1482–90.PubMedCrossRefGoogle Scholar
  61. 61.
    Palar K, et al. Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care. AIDS. 2012;26(18):2375–81.PubMedCrossRefGoogle Scholar
  62. 62.
    Weiser SD, 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.PubMedCentralPubMedCrossRefGoogle Scholar
  63. 63.
    McCoy SI, et al. Food insecurity, socioeconomic status, and HIV-related risk behavior among women in farming households in Tanzania. AIDS Behav. 2014;18(7):1224–36.Google Scholar
  64. 64.
    Riley ED, et al. Basic subsistence needs and overall health among human immunodeficiency virus-infected homeless and unstably housed women. Am J Epidemiol. 2011;174(5):515–22.PubMedCentralPubMedCrossRefGoogle Scholar
  65. 65.
    Mugavero MJ, Norton WE, Saag MS. Health care system and policy factors influencing engagement in HIV medical care: piecing together the fragments of a fractured health care delivery system. Clin Infect Dis. 2011;52(Suppl 2):S238–46.PubMedCentralPubMedCrossRefGoogle Scholar
  66. 66.
    McNairy ML, El-Sadr WM. The HIV care continuum: no partial credit given. AIDS. 2012;26(14):1735–8.Google Scholar
  67. 67.
    de Pee S, et al. Antiretroviral therapy requires life-long adherence. Lancet Infect Dis. 2012; 12(9):661–662; author reply 662.Google Scholar
  68. 68.
    Galarraga O, et al. Conditional economic incentives to improve HIV treatment adherence: literature review and theoretical considerations. AIDS Behav. 2013;17(7):2283–92.PubMedCentralPubMedCrossRefGoogle Scholar
  69. 69.
    McCoy SI. Comparing food and cash assistance for HIV-positive men and women on antiretroviral therapy in Tanzania. 2013 [cited 2014 06/07/2014].Google Scholar
  70. 70.
    Barnighausen T, et al. Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. Lancet Infect Dis. 2011;11(12):942–51.PubMedCentralPubMedCrossRefGoogle Scholar
  71. 71.
    Grobler L, et al. Nutritional interventions for reducing morbidity and mortality in people with HIV. Cochrane Database Syst Rev. 2013;2:CD004536.PubMedGoogle Scholar
  72. 72.
    Tirivayi N, Groot W. Health and welfare effects of integrating AIDS treatment with food assistance in resource constrained settings: a systematic review of theory and evidence. Soc Sci Med. 2011;73(5):685–92.PubMedCrossRefGoogle Scholar
  73. 73.
    Koethe JR, et al. Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings. Clin Infect Dis. 2009;49(5):787–98.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Amanda W. Singer
    • 1
  • Sheri D. Weiser
    • 2
  • Sandra I. McCoy
    • 1
  1. 1.Division of Epidemiology, School of Public HealthUniversity of CaliforniaBerkeleyUSA
  2. 2.Division of HIV/AIDS, San Francisco General Hospital, Department of MedicineUniversity of CaliforniaSan FranciscoUSA

Personalised recommendations