Medication Adherence and Health Outcomes of People Living with HIV Who Are Food Insecure and Prescribed Antiretrovirals That Should Be Taken with Food

Abstract

IntroductionFood insecurity is a well-established predictor of poor health outcomes. Antiretroviral therapies (ARTs) that should be taken with food to increase bioavailability may further challenge food insecure patients. This study examined factors associated with antiretroviral adherence and HIV viral suppression among people living with HIV who are food insecure and prescribed medications that require food.MethodsA community sample of 313 men and 105 women who experienced food insecurity in the previous month and were currently taking ART completed computerized interviews, urine screening for drug use, prospective biweekly unannounced pill count adherence assessments, and obtained their HIV viral load and CD4 cell counts from medical records.ResultsIndividuals taking ART regimens that should be taken with food were significantly more likely to be unemployed, were living longer with an HIV diagnosis, had lower CD4 cell counts, poorer HIV suppression, and endorsed more beliefs that taking medications was necessary for their health. Multivariable regression models controlling for potential confounding factors showed that receiving ART that requires food was significantly related to poorer ART adherence and unsuppressed HIV in this food insecure sample.ConclusionPeople living with HIV who are food insecure likely experience multiple facets of poverty that challenge their medication adherence, but food insecurity is the only such factor that is directly related to the pharmacokinetics of some antiretroviral medications. Achieving optimal treatment outcomes for HIV infection will require routine assessment of access to food when determining patient-tailored ART regimens.Electronic supplementary materialThe online version of this article (doi:10.1007/s40121-015-0057-y) contains supplementary material, which is available to authorized users.

Psychosocial correlates of nutritional status among people living with HIV on antiretroviral therapy: A matched case-control study in Central zone of Tigray, Northern Ethiopia

“…Another similarly matched case-control study by Berhe et al in Ethiopia, showed that people living with HIV enrolled on ART who were malnourished were far more likely to be non-adherent to ART compared to their matched counterparts [13]. This is strengthened further by findings a of study from Zambia which indicated that clinic-based food assistance is associated with increased medication adherence among HIV-infected adults on long-term antiretroviral therapy [19,20]. So, both malnutrition and poor adherence can affect one another and their synergetic effect may result in poor viral suppression [10,20].…”

Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses

“…It is important to appreciate the apparent substantial effect of socioeconomic factors on non-adherence, even in the current era of simpler and more tolerable drugs, with most participants on once a day regimens. There are a number of reasons why people with greater levels of social or financial disadvantage might have greater difficulties maintaining treatment adherence, including competing responsibilities and stress, unsettled living circumstances, food insecurity (particularly when ART regimen requires food), 27 increased prevalence of mental health problems, 18 stigma and low self-esteem, or less knowledge about the importance of adherence 28 . It is also conceivable that part of the effect of socioeconomic status on virological outcomes is independent of non-adherence, for example related to factors such as late diagnosis, 29 low CD4 count or AIDS at ART initiation, 30 differences in experiences or quality of health care, and pharmacokinetics through absence of sufficient food 31 …”

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

“…From their review, Singer, Weiser and McCoy [11] concluded that across multiple settings in resource poor and resource rich countries, food insecurity is an important barrier to ARV adherence. Several explanations for this relationship have been offered including purposeful non-adherence due to prescriptions with food requirements, side effects, competing resource demands, and the exacerbation of hunger during the initiation phase of ARVs [13, 14]. …”