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Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya

Abstract

Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0–27), social support (0–40), and HRQoL (8–40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: −64.3%, −15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.

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Acknowledgements

We thank the Kenya Medical Research Institute (KEMRI) for providing space within the FACES clinics for the work to be conducted, logistic support to conduct this research, and oversight in Kenya. We would also like to warmly thank study nurses and study trackers, as well as the mothers and their infants who participated in this study. Further, we thank the anonymous reviewers in the peer review process, whose comments significantly improved our analyses. The study (NCT02974972) was supported by the National Institute of Mental Health (NIH/NIMH K01 MH098902) and the National Institute of Allergy and Infectious Diseases (NIAID 2RO1AI098472).

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Wang, M., Miller, J.D., Collins, S.M. et al. Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya. AIDS Behav 24, 2885–2894 (2020). https://doi.org/10.1007/s10461-020-02839-9

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Keywords

  • Antiretroviral adherence
  • Hair ART drug concentrations
  • Food insecurity
  • Social support
  • Postpartum