Synergistic effects of food insecurity and drug use on medication adherence among people living with HIV infection
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Food insecurity and drug use are closely connected in the context of poverty, and both have been suggested to interfere with HIV medication adherence among people living with HIV/AIDS (PLWH). Yet the potential interaction between the two factors on adherence has not been examined. For this study we collected longitudinal data on HIV medication adherence among PLWH in Atlanta, GA, to assess a possible synergistic effect between the two factors on HIV medication adherence. People informed about the study came to the research site and completed an audio computer-assisted self-interview and instructions for pill counting. Over the next 5 weeks participants received three unscheduled follow-up phone assessments conducted 2 weeks apart to collect pill counts of their HIV medication. The prevalence of food insecurity was 60 % (488) and that of drug use was 33 % (274) in the sample of 809 participants. Among 770 participants who completed follow-up phone assessments, both food insecurity and drug use were associated with HIV medication adherence after adjusting for socio-demographic characteristics. The negative association between drug use and adherence persisted after further adjusting for health-related characteristics. Moreover, drug use appeared to moderate the effect of food insufficiency on adherence, with drug users who were food insufficient being the least likely to achieve 85 % adherence. Results from the current study demonstrate a synergism between food insecurity and drug use that may impede adherence among PLWH. The findings imply that the disruptive effects of food insecurity and drug use on adherence are likely to be intensified with the presence of each other, and encourage interventions to address the problem of HIV medication adherence from a multi-faceted perspective that takes into account detrimental combination of problem factors.
KeywordsFood insecurity Drug use HIV ART Adherence
This project was supported by National Institute of Drug Abuse Grant R01-DA017399.
Conflict of interest
Yiyun Chen and Seth C. Kalichman declare that they have no conflict of interest.
Human and animal rights and Informed Consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
- Anema, A., Chan, K., Chen, Y., Weiser, S., Montaner, J. S., & Hogg, R. S. (2013). Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada. PLoS ONE, 8, e61277. doi: 10.1371/journal.pone.0061277 CrossRefPubMedCentralPubMedGoogle Scholar
- Au, J. T., Kayitenkore, K., Shutes, E., Karita, E., Peters, P. J., Tichacek, A., & Allen, S. A. (2006). Access to adequate nutrition is a major potential obstacle to antiretroviral adherence among HIV-infected individuals in Rwanda. AIDS, 20, 2116–2118. doi: 10.1097/01.aids.0000247580.16073.1b CrossRefPubMedGoogle Scholar
- Barclay, T. R., Hinkin, C. H., Castellon, S. A., Mason, K. I., Reinhard, M. J., Marion, S. D., … & Durvasula, R. S. (2007). Age-associated predictors of medication adherence in HIV-positive adults: Health beliefs, self-efficacy, and neurocognitive status. Health Psychology, 2, 40–49. doi: 10.1037/0278-6220.127.116.11
- Campa, A., Yang, Z., Lai, S., Xue, L., Phillips, J. C., Sales, S., … & Baum, M. K. (2005). HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy. Clinical Infectious Diseases, 41, 1179–1185. doi: 10.1086/444499
- Carrieri, M. P., Villes, V., Raffi, F., Protopopescu, C., Preau, M., Salmon, D., … & Spire, B. (2007). Self-reported side-effects of anti-retroviral treatment among IDUs: a 7-year longitudinal study (APROCO-COPILOTE COHORT ANRS CO-8). International Journal of Drug Policy, 18, 288-295Google Scholar
- Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for measurement of food access: Indicator guide. Retrieved June 1, 2014.Google Scholar
- Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., … & Team, H. S. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. The New England Journal of Medicine, 365, 493–505. doi: 10.1056/NEJMoa1105243
- Hadland, S. E., Milloy, M. J., Kerr, T., Zhang, R., Guillemi, S., Hogg, R. S., … & Wood, E. (2012). Young age predicts poor antiretroviral adherence and viral load suppression among injection drug users. AIDS Patient Care STDS, 26, 274–280. doi: 10.1089/apc.2011.0196
- Himmelgreen, D. A., Perez-Escamilla, R., Segura-Millan, S., Romero-Daza, N., Tanasescu, M., & Singer, M. (1998). A comparison of the nutritional status and food security of drug-using and non-drug-using Hispanic women in Hartford, Connecticut. American Journal of Physical Anthropology, 107, 351–361. doi: 10.1002/(SICI)1096-8644(199811)107:3<351:AID-AJPA10>3.0.CO;2-7 CrossRefPubMedGoogle Scholar
- Hinkin, C. H., Barclay, T. R., Castellon, S. A., Levine, A. J., Durvasula, R. S., Marion, S. D., … & Longshore, D. (2007). Drug use and medication adherence among HIV-1 infected individuals. AIDS Behavior, 11, 185–194. doi: 10.1007/s10461-006-9152-0
- Kalichman, S. C., Amaral, C. M., Cherry, C., Flanagan, J., Pope, H., Eaton, L., … & Schinazi, R. F. (2008). Monitoring medication adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clinical Trials, 9, 298–308. doi: 10.1310/hct0905-298
- Kalichman, S. C., Pellowski, J., Kalichman, M. O., Cherry, C., Detorio, M., Caliendo, A. M., & Schinazi, R. F. (2011). Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. Prevention Science, 12, 324–332. doi: 10.1007/s11121-011-0222-9 CrossRefPubMedGoogle Scholar
- Musumari, P. M., Wouters, E., Kayembe, P. K., Kiumbu Nzita, M., Mbikayi, S. M., Suguimoto, S. P., … & Kihara, M. (2014). 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, 9, e85327. doi: 10.1371/journal.pone.0085327
- Peretti-Watel, P., Spire, B., Schiltz, M. A., Bouhnik, A. D., Heard, I., Lert, F., … & Group, V. (2006). Vulnerability, unsafe sex and non-adherence to HAART: Evidence from a large sample of French HIV/AIDS outpatients. Social Science and Medicine, 62, 2420–2433. doi: 10.1016/j.socscimed.2005.10.020
- Shannon, K., Kerr, T., Milloy, M. J., Anema, A., Zhang, R., Montaner, J. S., & Wood, E. (2011). Severe food insecurity is associated with elevated unprotected sex among HIV-seropositive injection drug users independent of HAART use. AIDS, 25, 2037–2042. doi: 10.1097/QAD.0b013e32834b35c9 CrossRefPubMedCentralPubMedGoogle Scholar
- StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.Google Scholar
- USDA. (2006). Food Insecurity and Hunger in the United States: An assessment of the measure. Washington: National Academies Press.Google Scholar
- Weiser, S. D., Bangsberg, D. R., Kegeles, S., Ragland, K., Kushel, M. B., & Frongillo, E. A. (2009a). Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behavior, 13, 841–848. doi: 10.1007/s10461-009-9597-z CrossRefPubMedCentralPubMedGoogle Scholar
- Weiser, S. D., Fernandes, K. A., Brandson, E. K., Lima, V. D., Anema, A., Bangsberg, D. R., … & Hogg, R. S. (2009). The association between food insecurity and mortality among HIV-infected individuals on HAART. Journal of Acquired Immune Deficiency Syndromes, 52, 342–349. doi: 10.1097/QAI.0b013e3181b627c2
- Weiser, S. D., Frongillo, E. A., Ragland, K., Hogg, R. S., Riley, E. D., & Bangsberg, D. R. (2009c). Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. Journal of General Internal Medicine, 24, 14–20. doi: 10.1007/s11606-008-0824-5 CrossRefPubMedCentralPubMedGoogle Scholar
- Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., … & Bangsberg, D. R. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition, 94, 1729S–1739S. doi: 10.3945/ajcn.111.012070
- Wood, E., Hogg, R. S., Yip, B., Moore, D., Harrigan, P. R., & Montaner, J. S. (2006). Impact of baseline viral load and adherence on survival of HIV-infected adults with baseline CD4 cell counts > or = 200 cells/microl. AIDS, 20, 1117–1123. doi: 10.1097/01.aids.0000226951.49353.ed CrossRefPubMedGoogle Scholar