The impact of food insecurity on HIV outcomes in Senegal, West Africa: a prospective longitudinal study

BMC Public Health

Ibrahima Tito Tamba¹  Jacques F. Sambou²  Ibrahima Sall²  Dominique Faye²  Jean Philippe Diatta²  Jean Jacques Malomar²  Ousseynou Cisse²  Stephen E. Hawes³  Noelle A. Benzekri⁴  Geoffrey S. Gottlieb⁵  Cheikh T. Ndour⁶  Khadim Faye⁷  Papa Salif Sow⁷  Mouhamadou Baïla Diallo⁷  Moussa Seydi⁷  Sanou Ndong⁷  Ndèye Fatou Ngom Guèye⁷  Fatima Sall⁷ 

[1] Centre de Santé de Bignona, Bignona, Senegal;Centre de Santé de Ziguinchor, Ziguinchor, Senegal;Department of Epidemiology, University of Washington, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Department of Medicine, University of Washington, Box 358061, 750 Republican St., 98109-4725, Seattle, WA, USA;Department of Medicine, University of Washington, Box 358061, 750 Republican St., 98109-4725, Seattle, WA, USA;Department of Global Health, University of Washington, Seattle, WA, USA;Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l’Action Sociale, Dakar, Senegal;Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal;

关键词: HIV/AIDS;    Food insecurity;    Virologic failure;    Loss to follow-up;    Adherence;    Nutrition;    Stigma;    Social determinants;    Agriculture;    Care cascade;    Senegal;    West Africa;   

DOI  :  10.1186/s12889-021-10444-1

来源: Springer

【 摘 要 】

BackgroundUnderstanding the impact of food insecurity on HIV outcomes is critical for the development and implementation of effective, evidence-based interventions to address food insecurity and improve the HIV care cascade. We conducted a prospective, longitudinal study to determine the impact of food insecurity on HIV outcomes in Senegal, West Africa.MethodsHIV-infected individuals presenting for care and initiation of ART through the Senegalese National AIDS program in Dakar and Ziguinchor were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart review at enrollment, month 6, and month 12. Logistic regression was used to determine the association between food insecurity and HIV outcomes.ResultsAmong the 207 participants in this study, 70% were female and the median age was 37 years. The majority (69%) were food insecure at enrollment, 29% were severely food insecure, and 38% were undernourished. Nearly a third (32%) had no formal education, 23% practiced agriculture, and 40% owned livestock. The median daily food expenditure per person was $0.58. The median round trip transportation time to clinic was 90 min (IQR 30–240). The median cost of transportation to clinic was $1.74. At month 12, 69% were food insecure, 23% were severely food insecure, and 14% were undernourished. At month 12, 43% had not disclosed their HIV status; food insecurity was associated with non-disclosure of HIV-status due to fear of stigmatization and feelings of shame. Severe food insecurity was a strong predictor of loss to follow-up (OR 3.13 [1.08–9.06]) and persistent severe food insecurity was associated with virologic failure (OR 5.14 [1.01–26.29]) and poor adherence to ART 8.00 [1.11–57.57]. Poor nutritional status was associated with poor immunologic recovery (OR 4.24 [1.56–11.47]), virologic failure (OR 3.39 [1.13–10.21]), and death (OR 3.35 [1.40–8.03]).ConclusionSeverity and duration of food insecurity are important factors in understanding the relationship between food insecurity and HIV outcomes. Our findings highlight the importance of nutritional status, socioeconomic opportunity, and self-stigmatization in the complex pathway between food insecurity and HIV outcomes. Interdisciplinary, multisectoral efforts are needed to develop and implement effective interventions to address food insecurity among people living with HIV.

【 授权许可】

CC BY