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

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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.

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Acknowledgments

Ms. Singer acknowledges support from NIEHS R01 ES09137. Dr. McCoy is supported by Award Number K01MH094246 from the National Institute of Mental Health. Dr. Weiser acknowledges support from the Burke Global Health Family Foundation, and NIMH K23 MH079713. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health, the National Institute of Environmental Health Sciences, or the National Institutes of Health. The funding bodies had no role in the study. We thank Dr. Nancy Padian for helpful comments on the manuscript.

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Authors and Affiliations

  1. Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA

    Amanda W. Singer & Sandra I. McCoy

  2. Division of HIV/AIDS, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA

    Sheri D. Weiser

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  1. Amanda W. Singer
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  2. Sheri D. Weiser
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Correspondence to Amanda W. Singer.

Appendix

Appendix

Full PubMed Search strategy: (“Antiretroviral Therapy, Highly Active”[Mesh] OR “HIV Infections/drug therapy”[Mesh] OR “Anti-HIV Agents/therapeutic use”[Mesh] OR “Acquired Immunodeficiency Syndrome/drug therapy”[Mesh] OR antiretroviral OR HAART OR ART) AND (“Patient Compliance”[Mesh] OR “Medication adherence”[Mesh] OR adherence OR nonadherence OR non-adherence) AND (“Food Supply”[Mesh] OR food OR hunger OR “Socioeconomic factors”[Mesh] OR “risk factors” OR poverty OR barrier OR nutrition OR malnutrition).

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Singer, A.W., Weiser, S.D. & McCoy, S.I. Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review. AIDS Behav 19, 1510–1526 (2015). https://doi.org/10.1007/s10461-014-0873-1

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