Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco

Sheri D. Weiser, Edward A. Frongillo, Kathleen Ragland, Robert S. Hogg, Elise D. Riley, David Bangsberg

Research output: Contribution to journalArticle

152 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients. DESIGN: This is a cross-sectional study. PARTICIPANTS AND SETTING: Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort. MEASUREMENTS: Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to <50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression. RESULTS: Among 104 participants, 51% were food secure, 24% were mildly or moderately food insecure and 25% were severely food insecure. Severely food insecure participants were less likely to have adherence >=80%. In adjusted analyses, severe food insecurity was associated with a 77% lower odds of viral suppression (95% CI = 0.06-0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85% lower odds of viral suppression (95% CI = 0.02-0.99) among those with <=80% adherence and a 66% lower odds among those with >80% adherence (95% CI = 0.06-1.81). CONCLUSIONS: Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.

Original languageEnglish (US)
Pages (from-to)14-20
Number of pages7
JournalJournal of General Internal Medicine
Volume24
Issue number1
DOIs
StatePublished - Jan 2009
Externally publishedYes

Fingerprint

San Francisco
Food Supply
HIV
RNA
Viral RNA
Viral Load
Public Health
Cross-Sectional Studies
Outcome Assessment (Health Care)
Food
Research

Keywords

  • Adherence
  • Food insecurity
  • HIV viral load suppression
  • HIV/AIDS
  • Homeless
  • San Francisco

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. / Weiser, Sheri D.; Frongillo, Edward A.; Ragland, Kathleen; Hogg, Robert S.; Riley, Elise D.; Bangsberg, David.

In: Journal of General Internal Medicine, Vol. 24, No. 1, 01.2009, p. 14-20.

Research output: Contribution to journalArticle

Weiser, Sheri D. ; Frongillo, Edward A. ; Ragland, Kathleen ; Hogg, Robert S. ; Riley, Elise D. ; Bangsberg, David. / Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. In: Journal of General Internal Medicine. 2009 ; Vol. 24, No. 1. pp. 14-20.
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abstract = "BACKGROUND AND OBJECTIVES: There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients. DESIGN: This is a cross-sectional study. PARTICIPANTS AND SETTING: Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort. MEASUREMENTS: Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to <50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression. RESULTS: Among 104 participants, 51{\%} were food secure, 24{\%} were mildly or moderately food insecure and 25{\%} were severely food insecure. Severely food insecure participants were less likely to have adherence >=80{\%}. In adjusted analyses, severe food insecurity was associated with a 77{\%} lower odds of viral suppression (95{\%} CI = 0.06-0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85{\%} lower odds of viral suppression (95{\%} CI = 0.02-0.99) among those with <=80{\%} adherence and a 66{\%} lower odds among those with >80{\%} adherence (95{\%} CI = 0.06-1.81). CONCLUSIONS: Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.",
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AU - Weiser, Sheri D.

AU - Frongillo, Edward A.

AU - Ragland, Kathleen

AU - Hogg, Robert S.

AU - Riley, Elise D.

AU - Bangsberg, David

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AB - BACKGROUND AND OBJECTIVES: There is growing international concern that food insecurity may negatively impact antiretroviral (ARV) treatment outcomes, but no studies have directly evaluated the effect of food insecurity on viral load suppression and antiretroviral adherence. We hypothesized that food insecurity would be associated with poor virologic response among homeless and marginally housed HIV-positive ARV-treated patients. DESIGN: This is a cross-sectional study. PARTICIPANTS AND SETTING: Participants were ARV-treated homeless and marginally housed persons receiving adherence monitoring with unannounced pill counts in the Research on Access to Care in the Homeless (REACH) Cohort. MEASUREMENTS: Food insecurity was measured by the Household Food Insecurity Access Scale (HFIAS). The primary outcome was suppression of HIV viral RNA to <50 copies/ml. We used multivariate logistic regression to assess whether food insecurity was associated with viral suppression. RESULTS: Among 104 participants, 51% were food secure, 24% were mildly or moderately food insecure and 25% were severely food insecure. Severely food insecure participants were less likely to have adherence >=80%. In adjusted analyses, severe food insecurity was associated with a 77% lower odds of viral suppression (95% CI = 0.06-0.82) when controlling for all covariates. In analyses stratified by adherence level, severe food insecurity was associated with an 85% lower odds of viral suppression (95% CI = 0.02-0.99) among those with <=80% adherence and a 66% lower odds among those with >80% adherence (95% CI = 0.06-1.81). CONCLUSIONS: Food insecurity is present in half of the HIV-positive urban poor in San Francisco, one of the best resourced settings for HIV-positive individuals in the United States, and is associated with incomplete viral suppression. These findings suggest that ensuring access to food should be an integral component of public health HIV programs serving impoverished populations.

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