Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda

Sheri D. Weiser, Reshma Gupta, Alexander C. Tsai, Edward A. Frongillo, Nils Grede, Elias Kumbakumba, Annet Kawuma, Peter W. Hunt, Jeffrey N. Martin, David Bangsberg

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status. DESIGN: The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda. METHODS: Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics. RESULTS: Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b =-1.6; 95% confidence interval:-2.7 to-0.45) and ending with the final quarter (b =-6.4; 95% confidence interval:-10.3 to-2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security. CONCLUSIONS: Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.

Original languageEnglish (US)
Pages (from-to)179-186
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume61
Issue number2
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

Fingerprint

Uganda
Food Supply
Nutritional Status
Health Status
HIV
Therapeutics
Confidence Intervals
Acquired Immunodeficiency Syndrome
Outcome Assessment (Health Care)
Interviews
Food

Keywords

  • antiretroviral treatment
  • food insecurity
  • HIV
  • nutrition
  • physical health status
  • Uganda

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda. / Weiser, Sheri D.; Gupta, Reshma; Tsai, Alexander C.; Frongillo, Edward A.; Grede, Nils; Kumbakumba, Elias; Kawuma, Annet; Hunt, Peter W.; Martin, Jeffrey N.; Bangsberg, David.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 61, No. 2, 01.10.2012, p. 179-186.

Research output: Contribution to journalArticle

Weiser, Sheri D. ; Gupta, Reshma ; Tsai, Alexander C. ; Frongillo, Edward A. ; Grede, Nils ; Kumbakumba, Elias ; Kawuma, Annet ; Hunt, Peter W. ; Martin, Jeffrey N. ; Bangsberg, David. / Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda. In: Journal of Acquired Immune Deficiency Syndromes. 2012 ; Vol. 61, No. 2. pp. 179-186.
@article{269f441218204114a09f2e9573a3f8ab,
title = "Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda",
abstract = "OBJECTIVE: To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status. DESIGN: The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda. METHODS: Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics. RESULTS: Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41{\%} were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b =-1.6; 95{\%} confidence interval:-2.7 to-0.45) and ending with the final quarter (b =-6.4; 95{\%} confidence interval:-10.3 to-2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security. CONCLUSIONS: Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.",
keywords = "antiretroviral treatment, food insecurity, HIV, nutrition, physical health status, Uganda",
author = "Weiser, {Sheri D.} and Reshma Gupta and Tsai, {Alexander C.} and Frongillo, {Edward A.} and Nils Grede and Elias Kumbakumba and Annet Kawuma and Hunt, {Peter W.} and Martin, {Jeffrey N.} and David Bangsberg",
year = "2012",
month = "10",
day = "1",
doi = "10.1097/QAI.0b013e318261f064",
language = "English (US)",
volume = "61",
pages = "179--186",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda

AU - Weiser, Sheri D.

AU - Gupta, Reshma

AU - Tsai, Alexander C.

AU - Frongillo, Edward A.

AU - Grede, Nils

AU - Kumbakumba, Elias

AU - Kawuma, Annet

AU - Hunt, Peter W.

AU - Martin, Jeffrey N.

AU - Bangsberg, David

PY - 2012/10/1

Y1 - 2012/10/1

N2 - OBJECTIVE: To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status. DESIGN: The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda. METHODS: Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics. RESULTS: Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b =-1.6; 95% confidence interval:-2.7 to-0.45) and ending with the final quarter (b =-6.4; 95% confidence interval:-10.3 to-2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security. CONCLUSIONS: Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.

AB - OBJECTIVE: To investigate whether time on antiretroviral therapy (ART) is associated with improvements in food security and nutritional status, and the extent to which associations are mediated by improved physical health status. DESIGN: The Uganda AIDS Rural Treatment Outcomes study, a prospective cohort of HIV-infected adults newly initiating ART in Mbarara, Uganda. METHODS: Participants initiating ART underwent quarterly structured interview and blood draws. The primary explanatory variable was time on ART, constructed as a set of binary variables for each 3-month period. Outcomes were food insecurity, nutritional status, and PHS. We fit multiple regression models with cluster-correlated robust estimates of variance to account for within-person dependence of observations over time, and analyses were adjusted for clinical and sociodemographic characteristics. RESULTS: Two hundred twenty-eight ART-naive participants were followed for up to 3 years, and 41% were severely food insecure at baseline. The mean food insecurity score progressively declined (test for linear trend P < 0.0001), beginning with the second quarter (b =-1.6; 95% confidence interval:-2.7 to-0.45) and ending with the final quarter (b =-6.4; 95% confidence interval:-10.3 to-2.5). PHS and nutritional status improved in a linear fashion over study follow-up (P < 0.001). Inclusion of PHS in the regression model attenuated the relationship between ART duration and food security. CONCLUSIONS: Among HIV-infected individuals in Uganda, food insecurity decreased and nutritional status and PHS improved over time after initiation of ART. Changes in food insecurity were partially explained by improvements in PHS. These data support early initiation of ART in resource-poor settings before decline in functional status to prevent worsening food insecurity and its detrimental effects on HIV treatment outcomes.

KW - antiretroviral treatment

KW - food insecurity

KW - HIV

KW - nutrition

KW - physical health status

KW - Uganda

UR - http://www.scopus.com/inward/record.url?scp=84867032768&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84867032768&partnerID=8YFLogxK

U2 - 10.1097/QAI.0b013e318261f064

DO - 10.1097/QAI.0b013e318261f064

M3 - Article

C2 - 22692093

AN - SCOPUS:84867032768

VL - 61

SP - 179

EP - 186

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 2

ER -