Abstract
BackgroundFood insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC).Methods and FindingsThis is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38–3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15–3.32) and decreased (AOR, 0.31; CI, 0.11–0.83) odds of non-adherence to ART.ConclusionFood insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa.
Highlights
The benefits of antiretroviral therapy (ART) in reducing HIV/ AIDS related-morbidity and mortality are extensively documented [1,2,3]
Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and the long-term success of HIV treatment in Sub-Saharan Africa
In our preliminary qualitative study, we found that food insecurity, financial constraints, forgetfulness, and fear of disclosure/stigma were common barriers to ART adherence; while religious beliefs were both a barrier and facilitator of ART adherence among HIVpositive adults in the Democratic Republic of Congo (DRC) [23]
Summary
The benefits of antiretroviral therapy (ART) in reducing HIV/ AIDS related-morbidity and mortality are extensively documented [1,2,3]. Recent evidence indicates that early initiation of ART substantially reduces sexual transmission of HIV at individual [4,5] and population levels [6]; conferring ART a crucial place in both treatment and prevention of HIV/AIDS. Food insecurity has emerged as a key structural barrier that affects adherence to ART in both resource-rich and constrained settings. Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. Unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC)
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