Abstract

The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5–18.5 kg/m2. Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV–TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa.

Highlights

  • Licensee MDPI, Basel, Switzerland.Joint United Nations Programme on HIV/AIDs (UNAIDS) data estimate that 25.5 million people are living with HIV/AIDs (PWH) in Africa, which accounts for 68% of the global population living with HIV/AIDS [1]

  • The findings revealed a high prevalence of malnutrition and household food insecurity among people living with HIV/AIDS on antiretroviral therapy

  • We found that treatment adherence was impacted negatively by social factors such as stigma and individual-level factors such as patients not prioritizing treatment, temporary relief felt by patients, and significant side effects of antiretroviral therapy (ART) and TB treatment regimens [55]

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Summary

Introduction

Joint United Nations Programme on HIV/AIDs (UNAIDS) data estimate that 25.5 million people are living with HIV/AIDs (PWH) in Africa, which accounts for 68% of the global population living with HIV/AIDS [1]. The use of highly active antiretroviral therapy (HAART) has significantly prolonged the life expectancy of PWH and improved health outcomes, Africa continues to experience a high incidence of HIV/AIDS with two-thirds of all new global cases occurring on the continent [2].

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