Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

Jason M Nagata,Craig R Cohen,Edward A Frongillo,Lisa M Butler,A Rain Mocello,Rachel Burger,Elly Weke,Joshua D Miller,Lila A Sheira,Sera L Young,Phelgona Otieno,Sheri D Weiser,Pauline Wekesa,Elizabeth A Bukusi

doi:10.1007/s10461-021-03410-w

Abstract

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0–51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI −3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

Highlights

MethodsGlobal water crises present substantial threats to human health and economic productivity [1]
Each five-unit higher household water insecurity score was associated with 1.21 higher odds of having a viral load ≥ 1000 and 1.26 higher odds of a recent AIDS-defining illness
Household water insecurity was not associated with CD4 cell count in either model

Summary

Introduction

MethodsGlobal water crises present substantial threats to human health and economic productivity [1]. Understanding the relationship between water insecurity, i.e. the inability to access adequate and safe water for a healthy and productive life [3], and HIV-related outcomes is critical for addressing these often co-occurring epidemics [9]. Food insecurity is a critical social determinant of health, including HIV-related clinical outcomes [13,14,15,16]. Food insecurity increases an individual’s risk of malnutrition, depression, and anxiety [17,18,19,20]; these conditions can limit the ability of individuals to access health care services and lower adherence to antiretroviral therapy (ART) regimens, which are in turn associated with higher viral loads, lack of sustained viral suppression, and lower CD4 cell counts [13, 21,22,23]. Water insecurity may be a critical health determinant, few data have linked water insecurity to HIV-related outcomes [8]. Water insecurity may be a driver of food insecurity since water is required for food production and preparation [6, 11, 24], such that water insecurity may both directly and indirectly undermine well-being [25, 26]

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Conclusion