Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya

Abstract

Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0-27), social support (0-40), and HRQoL (8-40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: −64.3%, −15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

“…Lack of proper clothing and food insecurity were among the main socioeconomic constraints that negatively affected retention of HIV treatment found in the present study that even got worse in the COVID-19 pandemic. These factors have also been reported in other studies conducted in Togo, Ethiopia and Kenya (Bezabhe et al, 2014;Yaya et al, 2014;Aibibula et al, 2017;Wang et al, 2020). Patients usually lose follow-up when they migrate either within Pakistan or overseas for work purposes (Ahmed et al, 2020b).…”

“…Some qualitative studies have reported barriers that include forgetfulness, fatigue, hopelessness (Jones et al, 2015), stigma and discrimination (Wasti et al, 2012), HIV non-disclosure (Arnold et al, 2014), and religious beliefs (Holtzman et al, 2015;Medved Kendrick, 2017). Facilitators of retention to treatment include family support (Yehia et al, 2015), positive relationship with healthcare providers (Nam et al, 2008), access to affordable transportation (Yehia et al, 2015), livelihood support (Wang et al, 2020), improved knowledge about the disease (Ammon et al, 2018), reminders (Nam et al, 2008), attending a support group (Wang et al, 2020), and carrying ART while away from home (Kumarasamy et al, 2005;Croome et al, 2017). Many of the reported barriers and facilitators are implicated in the Pakistani context; however, some may be unique and not reported in the literature.…”

Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

“…Household wealth was derived using a principal components analysis of a household's ownership of assets and dwelling characteristics (roof materials, sanitation facilities) using methods from the Demographic and Health Surveys [33]. Household food insecurity in the prior 30 days was based on the 9-item Household Food Insecurity Access Scale (range: 0-27) [12], a measure that has been crossculturally validated and previously used among adults living with HIV in Kenya [6,[34][35][36].…”

Examining the relationship between interpersonal support and retention in HIV care among HIV+ nursing mothers in Uganda

“…Social support or interpersonal support is defined as the existence or availability of people who let an individual know that they care about, value, and love them [14]. Perceived social support contributes to retention in HIV care, ART adherence and general wellbeing of nursing mothers living with HIV [15,16]. Postpartum period and HIV are two medically independent complex phenomena.…”