Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania.

Amon Exavery,Christina Kyaruzi,Asheri Barankena,Ramadhani Abdul,Levina Kikoyo,John Charles,Erica Kuhlik,Elizabeth Jere,Godfrey M Mubyazi,Marianna Balampama

doi:10.3389/fpubh.2021.719485

Abstract

The association between hunger and adherence to antiretroviral therapy (ART) is less known especially in vulnerable populations receiving HIV care and treatment services. Caregivers of orphans and vulnerable children (OVC) are vulnerable and likely to experience hunger due to additional economic pressure in caring for OVC. Using data from the community–based, USAID–funded Kizazi Kipya project, this study assesses the association between hunger and ART adherence among caregivers of OVC in Tanzania. HIV positive caregivers enrolled in the project from January to July 2017 were analyzed. The outcome variable was adherence to ART, defined as “not having missed any ART dose in the last 30 days,” and household hunger, measured using the Household Hunger Scale (HHS), was the main independent variable. Data analysis included multivariable logistic regression. The study analyzed 11,713 HIV positive caregivers who were on ART at the time of enrollment in the USAID Kizazi Kipya project in 2017. Aged 48.2 years on average, 72.9% of the caregivers were female. While 34.6% were in households with little to no hunger, 59.4 and 6.0% were in moderate hunger and severe hunger households, respectively. Overall, 90.0% of the caregivers did not miss any ART dose in the last 30 days. ART adherence rates declined as household hunger increased (p < 0.001). Multivariable analysis showed that the odds of adhering to ART was significantly lower by 42% among caregivers in moderate hunger households than those in little to no hunger households (OR = 0.58, 95% CI 0.50–0.68). The decline increased to 47% among those in severe hunger households (OR = 0.53, 95% CI 0.41–0.69). Hunger is an independent and a significant barrier to ART adherence among caregivers LHIV in Tanzania. Improving access to adequate food as part of HIV care and treatment services is likely to improve ART adherence in this population.

Highlights

Adherence to antiretroviral therapy (ART) is key to viral suppression for better health outcomes among people living with the Human Immunodeficiency Virus (PLHIV) [1,2,3]
Data were collected during screening and enrollment of beneficiaries which was conducted by community case workers (CCWs) and lead case workers (LCWs) using the project’s screening, enrollment, and Family and Child Asset Assessment (FCAA) tools between January– July 2017
The analysis was based on 11,713 HIV-positive caregivers aged at least 19 years who were already on ART at the time of enrollment in the project

Summary

Introduction

Adherence to antiretroviral therapy (ART) is key to viral suppression for better health outcomes among people living with the Human Immunodeficiency Virus (PLHIV) [1,2,3]. The central theme of the test and treat approach is that if people can be identified early on in their infection, start and stay on treatment (adherence) to achieve viral suppression, the onward transmission of HIV will be prevented, impacting HIV incidence at a population level [33] This is demonstrated by a large and growing body of clinical evidence showing that if an HIV positive person adheres to ART, the amount of HIV in the body (viral load) declines to a very low level, and when they are below 200 copies per milliliter of blood, a condition called “an undetectable viral load” [34], transmission of the HIV to others through sex or syringe sharing, and from mother to child during pregnancy, birth, and breastfeeding is prevented [34,35,36,37].

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