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

Evaluation of Pill Counts Adherence with Self-Reported Adherence in Assessing Antiretroviral Therapy Behavior of Women living with HIV at a Faith-based Clinic in Malawi

“…It was found to be directly associated with VAS adherence and pill counts. This is in agreement with numerous studies and a meta-analysis [46][47][48] which have reported an association between food insecurity and ART adherence. Food insecurity has been found to be associated with poor antiretroviral adherence among people living with HIV (PLHIV) [49].…”

Transactional Fish-for-Sex Relationships Amid Declining Fish Access in Kenya

“…Our results have parallels to other literature demonstrating links between food insecurity, economic vulnerability, gendered power dynamics, and transactional sex or sex work (Chatterji, Murray, London, & Anglewicz, 2005;Cluver et al, 2012;Dunkle et al, 2007;Fielding-Miller, Mnisi, Adams, Baral, & Kennedy, 2014;Lwenya & Yongo, 2012;McCoy, Ralph, Njau, Msolla, & Padian, 2014;Robinson & Yeh, 2011). Further, these results position a gendered economy and environmental change as structural drivers of HIV, with parallels to other work on such drivers Govender, Seeley, & Watts, 2014;MacPherson et al, 2012) and the roles that persistent food insecurity and poverty play in perpetuating stigma (Tsai, Bangsberg, & Weiser, 2013) and undermining treatment adherence (Singer, Weiser, & McCoy, 2014;Weiser et al, 2014).…”

The Daily Relationship Between Aspects of Food Insecurity and Medication Adherence Among People Living with HIV with Recent Experiences of Hunger

“…Both malnutrition and HIV impact immune system functioning and when these two conditions co-occur the impact on the immune system is compounded and synergistic [9]. In addition to the detrimental impacts that food insecurity has on the physical health of people living with HIV, food insecurity has also been associated with worse health behaviors, such as lower antiretroviral (ARV) medication adherence and higher levels of sexual risk behavior [10, 11]. …”