Mechanisms from Food Insecurity to Worse HIV Treatment Outcomes in US Women Living with HIV.

Food insecurity (FI) contributes to HIV-related morbidity and mortality, but the mechanisms whereby FI negatively impacts HIV health are untested. We tested the hypothesis that FI leads to poor HIV clinical outcomes through nutritional, mental health, and behavioral paths. We analyzed data from Women's Interagency HIV Study (WIHS) among 1803 women living with HIV (WLWH) (8225 person-visits) collected from 2013 to 2015 biannually from nine sites across the United States participating in the WIHS. FI was measured with the US Household Food Security Survey Module. Outcomes included HIV viral nonsuppression, CD4 cell counts, and physical health status (PHS). We used longitudinal logistic and linear regression models with random effects to examine associations adjusting for covariates and path analysis to test nutritional, mental health, and behavioral paths. Increasing severity of FI was associated with unsuppressed viral load, lower CD4 counts, and worse PHS (all p < 0.05). Report of FI 6 months earlier was independently associated with most outcomes after adjusting for concurrent FI. For viral nonsuppression, the nutritional and behavioral paths accounted for 2.09% and 30.66% of the total effect, with the mental health path operating via serial mediation through the behavioral path. For CD4 count, the mental health and behavioral paths accounted for 15.21% and 17.0% of the total effect, respectively. For PHS, depressive symptoms accounted for 60.2% of the total effect. In conclusion, FI is associated with poor health among WLWH through different paths depending on the outcome. Interventions should target FI and its behavioral and mental health mechanisms to improve HIV outcomes.

[1]  Lawrence Busch,et al.  Food Security in the United States , 2021 .

[2]  Mardge H. Cohen,et al.  Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS , 2020, AIDS and Behavior.

[3]  P. Tien,et al.  Linking Depressive Symptoms to Viral Non-suppression among Women with HIV through Adherence Self-Efficacy and ART Adherence. , 2020, Journal of acquired immune deficiency syndromes.

[4]  S. Dunleavy,et al.  Medical, Mental Health, and Social Service Linkage Predicts Better HIV Outcomes: A Network Analytic Approach. , 2019, AIDS patient care and STDs.

[5]  J. Montaner,et al.  Substance use Patterns and HIV-1 RNA Viral Load Rebound among HIV-Positive Illicit Drug users in a Canadian Setting , 2019, Antiviral therapy.

[6]  Mardge H. Cohen,et al.  Longitudinal associations between food insecurity and substance use in a cohort of women with or at risk for HIV in the United States , 2018, Addiction.

[7]  Seth A. Berkowitz,et al.  Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries. , 2018, Health affairs.

[8]  Gina Wingood,et al.  Cohort Profile: The Women's Interagency HIV Study (WIHS). , 2018, International journal of epidemiology.

[9]  Mardge H. Cohen,et al.  Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States , 2017, AIDS and Behavior.

[10]  F. Hecht,et al.  Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health , 2017, Journal of Urban Health.

[11]  E. Frongillo,et al.  How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area. , 2016, Social science & medicine.

[12]  P. Fu,et al.  A comparative investigation of methods for longitudinal data with limits of detection through a case study , 2016, Statistical methods in medical research.

[13]  E. Frongillo,et al.  Food Insecurity and Health: A Conceptual Framework , 2015 .

[14]  S. Kalichman,et al.  Treatment Outcomes Among People Living With HIV Who Are Food Insecure and Prescribed Antiretrovirals Taken With Food , 2015, Journal of primary care & community health.

[15]  S. McCoy,et al.  A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS , 2014, AIDS and Behavior.

[16]  Mardge H. Cohen,et al.  Abuse and resilience in relation to HAART medication adherence and HIV viral load among women with HIV in the United States. , 2014, AIDS patient care and STDs.

[17]  D. Bangsberg,et al.  Food insecurity and HIV clinical outcomes in a longitudinal study of urban homeless and marginally housed HIV-infected individuals , 2013, AIDS.

[18]  B. Laraia Food insecurity and chronic disease. , 2013, Advances in nutrition.

[19]  J. Nachega,et al.  Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review , 2012, AIDS and Behavior.

[20]  Jeffrey N. Martin,et al.  Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. , 2012, Social science & medicine.

[21]  A. Tsai,et al.  Is Food Insecurity Associated with HIV Risk? Cross-Sectional Evidence from Sexually Active Women in Brazil , 2012, PLoS medicine.

[22]  P. Tien,et al.  Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. , 2011, The American journal of clinical nutrition.

[23]  J. Elliott,et al.  Repeated Assessments of Food Security Predict CD4 Change in the Setting of Antiretroviral Therapy , 2011, Journal of acquired immune deficiency syndromes.

[24]  A. Justice,et al.  Food Insecurity is Associated with Poor Virologic Response among HIV-Infected Patients Receiving Antiretroviral Medications , 2011, Journal of General Internal Medicine.

[25]  Kimberly A. Fernandes,et al.  High prevalence of food insecurity among HIV-infected individuals receiving HAART in a resource-rich setting , 2011, AIDS care.

[26]  K. Freedberg,et al.  Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study , 2010, AIDS research and therapy.

[27]  S. Kalichman,et al.  Health and Treatment Implications of Food Insufficiency among People Living with HIV/AIDS, Atlanta, Georgia , 2010, Journal of Urban Health.

[28]  S. Kegeles,et al.  Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/AIDS in San Francisco , 2009, AIDS and Behavior.

[29]  S. Segura-Pérez,et al.  Adaptation of the US Household Food Security Survey Module for Low-Income Pregnant Latinas: Qualitative Phase , 2009 .

[30]  S. Kirkpatrick,et al.  Food Insecurity and Participation in Community Food Programs among Low-income Toronto Families , 2009, Canadian journal of public health = Revue canadienne de sante publique.

[31]  Stacey L. Williams,et al.  Perceived Stigma of Poverty and dePreSSion: examination of interPerSonal and intraPerSonal mediatorS , 2008 .

[32]  L. Kaiser Why do low-income women not use food stamps? Findings from the California Women’s Health Survey , 2008, Public Health Nutrition.

[33]  S. Kirkpatrick,et al.  Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. , 2008, The Journal of nutrition.

[34]  L. Hurley,et al.  Effects of Depression and Selective Serotonin Reuptake Inhibitor Use on Adherence to Highly Active Antiretroviral Therapy and on Clinical Outcomes in HIV-Infected Patients , 2008, Journal of acquired immune deficiency syndromes.

[35]  D. Bangsberg,et al.  Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland , 2007, PLoS medicine.

[36]  E. Vittinghoff,et al.  Food Insecurity is Associated with Diabetes Mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002 , 2007, Journal of General Internal Medicine.

[37]  Ann E. Kurth,et al.  Self-Report Measures of Antiretroviral Therapy Adherence: A Review with Recommendations for HIV Research and Clinical Management , 2006, AIDS and Behavior.

[38]  David R. Williams,et al.  Food insufficiency and women's mental health: findings from a 3-year panel of welfare recipients. , 2005, Social science & medicine.

[39]  M. Young,et al.  The Women's Interagency HIV Study: an Observational Cohort Brings Clinical Sciences to the Bench , 2005, Clinical Diagnostic Laboratory Immunology.

[40]  R. Hogg,et al.  Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. , 2005, The Journal of nutrition.

[41]  H. Whittle,et al.  Body Mass Index at Time of HIV Diagnosis: A Strong and Independent Predictor of Survival , 2004, Journal of acquired immune deficiency syndromes.

[42]  서정헌,et al.  반도체 공정 overview , 2001 .

[43]  E. Frongillo,et al.  Nutritional and health consequences are associated with food insecurity among U.S. elderly persons. , 2001, The Journal of nutrition.

[44]  L. B. Dixon,et al.  Dietary intakes and serum nutrients differ between adults from food-insufficient and food-sufficient families: Third National Health and Nutrition Examination Survey, 1988-1994. , 2001, The Journal of nutrition.

[45]  D. Vlahov,et al.  Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. , 2001, JAMA.

[46]  Susan Swindells,et al.  Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection , 2000, Annals of Internal Medicine.

[47]  E. Frongillo Validation of measures of food insecurity and hunger. , 1999, The Journal of nutrition.

[48]  Joseph Feldman,et al.  The Women's Interagency HIV Study , 1998 .

[49]  A. Wu,et al.  Derivation and properties of a brief health status assessment instrument for use in HIV disease. , 1995, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[50]  L. Radloff The CES-D Scale , 1977 .

[51]  Christian A. Gregory,et al.  Household Food Security in the United States in 2018 , 2019 .

[52]  L. Adams,et al.  Using the Center for Epidemiologic Studies Depression Scale to Assess Depression in Women With HIV and Women at Risk for HIV: Are Somatic Items Invariant? , 2018, Psychological assessment.

[53]  J. Böhnke Explanation in causal inference: Methods for mediation and interaction. , 2016, Quarterly journal of experimental psychology.

[54]  D. Bangsberg,et al.  Food insecurity and HIV clinical outcomes in a longitudinal study of homeless and marginally housed HIV-infected individuals in San Francisco , 2013 .

[55]  I. Wilson,et al.  Evaluation of the Single-Item Self-Rating Adherence Scale for Use in Routine Clinical Care of People Living with HIV , 2012, AIDS and Behavior.

[56]  D. Bangsberg,et al.  Food Insecurity Is Associated with Greater Acute Care Utilization among HIV-Infected Homeless and Marginally Housed Individuals in San Francisco , 2012, Journal of General Internal Medicine.

[57]  M. Mimiaga,et al.  A systematic review of behavioral and treatment outcome studies among HIV-infected men who have sex with men who abuse crystal methamphetamine. , 2012, AIDS patient care and STDs.

[58]  S. Segura-Pérez,et al.  Adaptation of the U.S. Food Security Survey Module for Low-Income Pregnant Latinas: Qualitative Phase. , 2009, Journal of hunger & environmental nutrition.

[59]  A. Drewnowski,et al.  Poverty and obesity: the role of energy density and energy costs. , 2004, The American journal of clinical nutrition.

[60]  L. Radloff The CES-D Scale: A Self-Report Depression Scale for Research in the General Population — Source link , 2022 .