The association of household food insecurity and HIV infection with common mental disorders among newly diagnosed tuberculosis patients in Botswana

Abstract

Objective: To determine the association between food insecurity and HIV-infection with depression and anxiety among new tuberculosis patients. Design: Our cross-sectional study assessed depression, anxiety, and food insecurity with Patient Health Questionnaire (PHQ9), Zung Anxiety Self-Assessment Scale (ZUNG), and Household Food Insecurity Access Scale, respectively. Poisson regression models with robust variance were used to examine correlates of depression (PHQ9 ≥ 10) and anxiety (ZUNG ≥ 36). Setting: Gaborone, Botswana. Participants: Patients who were newly diagnosed with tuberculosis. Results: Between January and December 2019, we enrolled 180 TB patients from primary health clinics in Botswana. Overall, 99 (55.0%) were HIV-positive, 47 (26.1%), 85 (47.2%), and 69 (38.5%) indicated depression, anxiety, and moderate to severe food insecurity, respectively. After adjusting for potential confounders, food insecurity was associated with a higher prevalence of depression (adjusted prevalence ratio [aPR] = 2.30; 95% confidence interval [CI] = 1.40, 3.78) and anxiety (aPR = 1.41; 95% CI = 1.05, 1.91). Prevalence of depression and anxiety were similar between HIV-infected and -uninfected participants. Estimates remained comparable when restricted to HIV-infected participants. Conclusions: Mental disorders may be affected by food insecurity among new tuberculosis patients, regardless of HIV status.

HIV, Tuberculosis, and Food Insecurity in Africa—A Syndemics-Based Scoping Review

“…Reporting of food insecurity was inconsistent across the included articles. Besides the well-validated HFIAS [14,41,46,56,57], authors evaluated food insecurity by diagnosing malnutrition using BMI values [14,47,49,50,[52][53][54]58], mid-upper arm circumference (MUAC) [47][48][49], weight-for-height z-score [48], lean mass index (LMI) [51,52], fat mass index (FMI) [51,52], bioelectrical impedance analyzer (BIA) measurements [51,52], food energy/nutritional intake of macronutrients [43,45,51,54], dietary diversity score [53], weight gain or loss [14,41,51,53,57], clinical symptoms such as kwashiorkor, pellagra, and marasmus [43,45], qualitative reports of food availability [42,55], food sufficiency [42], or presence/absence of nutritional support [43,44,50]. A couple of the studies only reported a narrative description of food insecurity, without stating the measure used [42,44,…”

“…Among studies that used the Household Food Insecurity and Access Scale (HFIAS) to assess food insecurity (n = 5), all reported the presence of food insecurity [14,41,46,47,57] but only one study reported the actual HFIAS score, where the average score was 6 (range: 1-14) [41]. Another study at baseline started with 92% food insecurity at enrollment, which declined to 73% food insecurity, after the nutritional support and TB treatment initiative was administered for 6 months [14].…”

“…Another study at baseline started with 92% food insecurity at enrollment, which declined to 73% food insecurity, after the nutritional support and TB treatment initiative was administered for 6 months [14]. One study reported 51% of their participants being severely food insecure [47], another reported 48.5% of participants with HIV/AIDS and TB co-infection being food insecure, compared to 44.4% of participants without HIV being food insecure [57], and another reported 35.2% of their participants being food insecure, where food insecure households were significantly more undernourished (p = 0.0001) [46]. In one study, low BMI and LMI increased the hazard of death among HIV/AIDS and TB co-infected individuals, in addition to other risk factors including being older than 30 years old, being male, and having a history of weight loss [53].…”

“…Moreover, economic, social, and health facility service barriers discouraged co-infected individuals from accessing and adhering to ART and TB treatments [44]. In addition, not all co-infected individuals were aware of their HIV or TB diagnosis and not all had received prior ART or TB treatment [51,57].…”

“…Some studies (n = 7) documented HIV-and TB-related treatment adherence and health behaviors amongst co-infected individuals [14,41,42,44,51,56,57]. Treatment non-adherence was reported as the inconsistent and incorrect use of medication or treatment as prescribed by health providers, and was reported in several studies [14,42,44,51,56,57]; in one study, 31% of the individuals with HIV/AIDS and TB co-infection were reported as non-adherent to treatment [57]. Other documented related health behaviors included: if the patient was on treatment (e.g., medications such as ART) and had access to treatment [41,42,44,51].…”