Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting

Sheri D. Weiser, Alexander C. Tsai, Reshma Gupta, Edward A. Frongillo, Annet Kawuma, Jude Senkungu, Peter W. Hunt, Nneka I. Emenyonu, Jennifer E. Mattson, Jeffrey N. Martin, David Bangsberg

Research output: Contribution to journalArticle

98 Citations (Scopus)

Abstract

Objective: We undertook a longitudinal study in rural Uganda to understand the association of food insecurity with morbidity and patterns of healthcare utilization among HIV-infected individuals enrolled in an antiretroviral therapy program. Design: Longitudinal cohort study. Methods: Participants were enrolled from the Uganda AIDS Rural Treatment Outcomes cohort, and underwent quarterly structured interviews and blood draws. The primary predictor was food insecurity measured by the validated Household Food Insecurity Access Scale. Primary outcomes included health-related quality of life measured by the validated Medical Outcomes Study-HIV Physical Health Summary (PHS), incident self-reported opportunistic infections, number of hospitalizations, and missed clinic visits. To estimate model parameters, we used the method of generalized estimating equations, adjusting for sociodemographic and clinical variables. Explanatory variables were lagged by 3 months to strengthen causal interpretations. Results: Beginning in May 2007, 458 persons were followed for a median of 2.07 years, and 40% were severely food insecure at baseline. Severe food insecurity was associated with worse PHS, opportunistic infections, and increased hospitalizations (results were similar in concurrent and lagged models). Mild/moderate food insecurity was associated with missed clinic visits in concurrent models, whereas in lagged models, severe food insecurity was associated with reduced odds of missed clinic visits. Conclusion: Based on the negative impact of food insecurity on morbidity and patterns of healthcare utilization among HIV-infected individuals, policies and programs that address food insecurity should be a critical component of HIV treatment programs worldwide.

Original languageEnglish (US)
Pages (from-to)67-75
Number of pages9
JournalAIDS
Volume26
Issue number1
DOIs
StatePublished - Jan 2 2012
Externally publishedYes

Fingerprint

Food Supply
HIV
Morbidity
Delivery of Health Care
Ambulatory Care
Uganda
Opportunistic Infections
Longitudinal Studies
Hospitalization
Health
Acquired Immunodeficiency Syndrome
Cohort Studies
Quality of Life
Outcome Assessment (Health Care)
Interviews
Food
Therapeutics

Keywords

  • AIDS
  • food insecurity
  • healthcare utilization
  • HIV
  • morbidity
  • Uganda

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. / Weiser, Sheri D.; Tsai, Alexander C.; Gupta, Reshma; Frongillo, Edward A.; Kawuma, Annet; Senkungu, Jude; Hunt, Peter W.; Emenyonu, Nneka I.; Mattson, Jennifer E.; Martin, Jeffrey N.; Bangsberg, David.

In: AIDS, Vol. 26, No. 1, 02.01.2012, p. 67-75.

Research output: Contribution to journalArticle

Weiser, SD, Tsai, AC, Gupta, R, Frongillo, EA, Kawuma, A, Senkungu, J, Hunt, PW, Emenyonu, NI, Mattson, JE, Martin, JN & Bangsberg, D 2012, 'Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting', AIDS, vol. 26, no. 1, pp. 67-75. https://doi.org/10.1097/QAD.0b013e32834cad37
Weiser, Sheri D. ; Tsai, Alexander C. ; Gupta, Reshma ; Frongillo, Edward A. ; Kawuma, Annet ; Senkungu, Jude ; Hunt, Peter W. ; Emenyonu, Nneka I. ; Mattson, Jennifer E. ; Martin, Jeffrey N. ; Bangsberg, David. / Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. In: AIDS. 2012 ; Vol. 26, No. 1. pp. 67-75.
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