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Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care

Palar, Kartikaa,b; Wagner, Glennb; Ghosh-Dastidar, Bonnieb; Mugyenyi, Peterc

AIDS:
doi: 10.1097/QAD.0b013e328359b809
Epidemiology and Social
Abstract

Objective: Although the physical health benefits of HIV antiretroviral therapy (ART) are well documented, the socioeconomic benefits are still being established. Few studies have examined the effects of ART on food insecurity, although studies suggest there may be a benefit via improved health and ability to work.

Design: Twelve-month prospective cohort study of 602 treatment-naive patients initiating clinical care in Uganda.

Methods: Longitudinal multivariate logistic regression was used to investigate the effect of ART on food insecurity compared to HIV care without ART. A staged regression approach was used to explore pathways through which ART may affect food insecurity.

Results: Food insecurity decreased significantly for both the ART and non-ART groups over time, with the ART group experiencing greater reductions by the end of the study. ART remained a significant predictor of reduction in food insecurity over time after controlling for baseline differences in the regression model (odds ratio 0.642; P < 0.01). Improvements in work and mental health status were identified as potential pathways through which ART may improve food security.

Conclusion: Taken together with the well known benefits of food security on ART adherence, treatment retention and clinical outcomes in resource-poor settings, our results suggest that a positive feedback loop of improved functioning and productivity could result from the interaction between food security and ART. Policymakers could leverage this positive cycle by strengthening mental health support and promoting sustainable food security interventions as part of HIV treatment programs.

Author Information

aDepartment of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles

bRAND Corporation, Santa Monica, California, USA

cJoint Clinical Research Centre, Kampala, Uganda.

Correspondence to Kartika Palar, PhD, Department of Health Services, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA 90095, USA. E-mail: kpalar@ucla.edu

Received 12 June, 2012

Revised 16 August, 2012

Accepted 24 August, 2012

© 2012 Lippincott Williams & Wilkins, Inc.