High levels of food insecurity were observed among HIV, TB, and HIV/TB co‐infected outpatients in northern Uganda

Abstract

IntroductionFood insecurity among individuals living with HIV is well‐recognized globally. Since comorbidity with TB is common, particularly in sub‐Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.Methods120 HIV+ only, 60 TB only and 60 HIV/TB co‐infected patients were systematically recruited from TB and HIV outpatient clinics at Gulu Regional Referral Hospital in northern Uganda. A survey consisting of participants socio‐demographic, household and food security variables was administered to study participants by trained interviewers. Food insecurity was assessed using the Individually‐focused FI Access Scale (IFIAS). Bivariate and multivariate regression models were used to compare continuous and categorical measures of FI among TB and HIV/TB co‐infected patients to that of patients infected with HIV only.ResultsCompared to TB or HIV/TB co‐infected patients, HIV infected patients were predominantly female. The Mean (SD) age of participants was 35.6 (11.3) and the age of TB or HIV/TB co‐infected patients did not differ significantly from that of HIV infected patients. Food insecurity (IFIAS) scores were 11.0 (5.9) and IFIAS scores of TB or HIV/TB co‐infected patients did not significantly differ from those of HIV infected patients in unadjusted or adjusted models. Overall, 55.4% and 89.6% of all participants reported experiencing severe and moderate‐to‐severe FI, respectively, and, like IFIAS scores, TB or HIV/TB co‐infected patients’ experience of severe or moderate‐to‐severe FI did not differ significantly from that of patients infected with HIV only.ConclusionWe observed high levels of food insecurity among HIV, TB, and HIV/TB outpatients and the experience of food insecurity in patients with TB or HIV/TB did not differ from that of patients with HIV infection.Support or Funding InformationPears Foundation IMPH Alumni Seed‐Grant ProgramHebrew University of Jerusalem‐Hadassah Braun School of Public Health. Characteristics of study participants overall and by HIV, TB, and HIV/TB co‐infection status. Variable All (n=240) HIV (n=120) TB (n=60) HIV/TB (n=60) Age 35.6 (11.3) 36.1 (9.9) 35.8 (15.5) 34.0 (8.7) Female gender 139 (58.2%) 94 (78.3%) 20 (33.3%)*** 25 (42.4%)*** Years of education 5.8 ± 4.6 4.8 ± 4.5 6.8 ± 4.3*** 7.0 ± 4.6*** Widowed 39 (16.3%) 24 (20.0%) 8 (13.3%)*** 7 (11.7%)**** Family size 5.2 ± 2.1 5.1 ± 2.1 5.8 ± 2.2*** 4.8 ± 2.0 Household asset score 8.7 ± 3.0 8.3 ± 2.5 9.3 ± 3.3*** 9.0 ± 3.4* Ever been displaced 191 (79.9%) 93 (77.5%) 51 (85.0%) 47 (79.6%) FI (IFIAS) score 11.0 ± 5.9 11.7 ± 5.6 10.5 ± 6.2* 10.0 ± 6.0* Moderate‐to‐severe FI 215 (89.6%) 111 (92.5%) 52 (86.7%) 52 (86.7%) Severe FI 133 (55.4%) 75 (62.5%) 26 (43.3%)*** 32 (53.3%) Estimates are mean ± SD or n (%n). p<0.2; p<0.1; p<0.05 compared to HIV‐only patients. Differences in food insecurity (IFIAS) scores among HIV, TB and HIV/TB co‐infected patients in northern Uganda Variable Unadjusted Adjusted* Effect STD P value Effect STD P value Disease status HIV+ Reference Reference TB only −1.20 0.93 0.1979 −0.61 0.84 0.4700 HIV/TB −1.67 0.94 0.0760 −0.92 0.84 0.2754 Adjusted for these variables: age, household assets score, family size, and marital status Differences in moderate‐to‐severe FI status among HIV, TB, and HIV/TB co‐infected patients in northern Uganda Variable Unadjusted Adjusted* OR 95%CI lower 95%CI upper p value OR 95%CI lower 95%CI upper p value Disease status HIV+ Reference Reference TB 0.53 1.19 1.44 0.2129 0.58 0.20 1.68 0.3160 HIV/TB 0.53 0.19 1.44 0.2129 0.66 0.23 1.88 0.4331 Adjusted for these variable: household assets score and family size Differences in severe FI status among HIV, TB, and HIV/TB co‐infected patients in northern Uganda Variable Unadjusted Adjusted* OR 95%CI lower 95%CI upper p value OR 95%CI lower 95%CI upper p value Disease status HIV+ Reference Reference TB 0.46 0.24 0.86 0.0154 0.50 0.25 1.02 0.0567 HIV/TB 0.69 0.37 1.28 0.2387 0.79 0.40 1.59 0.5147 Adjusted for these variable: household assets score and whether participants had ever been internally displaced