Abstract
Food insecurity disproportionately affects rural communities and people living with HIV (PLHIV). The Food Access Pilot Project (FAPP) was a California state-funded program that provided home-delivered, medically supportive meals via online meal vendors to food-insecure PLHIV in three rural counties. We performed longitudinal, retrospective analyses of FAPP participant data (n = 158; 504 and 460 person-time observations for viral load and CD4 count, respectively) over 36 months from a Ryan White client management database. Pre-post analyses demonstrated increased prevalence of food security and CD4 ≥ 500 between baseline and 12 months. Population-averaged trends using generalized estimating equations adjusted for participant demographics demonstrated increased odds of viral suppression and CD4 ≥ 500, and increased CD4 count (cells/mm3) for every six months of program enrollment. Home-delivered, medically supportive meals may improve food security status, HIV viral suppression, and immune health for low-income PLHIV in rural settings.
Highlights
Amongst people living with HIV (PLHIV), food insecurity—a state of limited access to nutritionally adequate food—is a well-documented driver of poor health outcomes, including lower viral load suppression and CD4 counts [1, 2], decreased adherence to antiretroviral therapy (ART) [1, 3, 4], increased acute care utilization [2], and increased mortality [5]
Humboldt is over 300 miles north of the San Francisco Bay Area near the Oregon border and is the most rural of the three counties; Napa is in the greater Bay Area and is home to many lower-income communities despite its famous wineries; and San Joaquin is located within the agricultural Central Valley, which is predominantly rural but contains urban centers (e.g. Stockton)
In this study investigating the health outcomes associated with weekly deliveries of medically supportive meals, we found that Food Access Pilot Project (FAPP) participation was associated with significant increases in the prevalence of food security and the odds of achieving viral suppression and healthy immune function over time
Summary
Amongst people living with HIV (PLHIV), food insecurity—a state of limited access to nutritionally adequate food—is a well-documented driver of poor health outcomes, including lower viral load suppression and CD4 counts [1, 2], decreased adherence to antiretroviral therapy (ART) [1, 3, 4], increased acute care utilization [2], and increased mortality [5]. PLHIV in rural areas have been found to experience delayed entry to care [8, 9] and increased HIV-related mortality [8, 10], which may be related to barriers such as unreliable transportation access [11,12,13], long distances to care [12], and limited access to providers with HIV expertise [13] In light of these negative associations between food insecurity, rural residence and HIV clinical outcomes, improving nutritional food access and HIV care have become increasingly recognized priorities in both urban and rural settings. In particular medically tailored meals, including those serving PLHIV [16], have been associated with fewer
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