title: A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia.
abstract: BACKGROUND
  The provision of food supplementation to food-insecure patients initiating antiretroviral therapy (ART) may improve adherence to medications.
  
  
  METHODS
  A home-based adherence support program at 8 government clinics assessed patients for food insecurity. Four clinics provided food supplementation, and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio), CD4, and weight gain outcomes among food-insecure patients enrolled at the food clinics with those enrolled at the control clinics.
  
  
  RESULTS
  Between May 1, 2004, and March 31, 2005, 636 food- insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. Two hundred fifty-eight of 366 (70%) patients in the food group achieved a medication possession ratio of 95% or greater versus 79 of 166 (48%) among controls (relative risk = 1.5; 95% confidence interval: 1.2 to 1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline World Health Organization stage, and baseline hemoglobin. We did not observe a significant effect of food supplementation on weight gain or CD4 cell response.
  
  
  CONCLUSIONS
  This analysis suggests that providing food to food-insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to ART patients is urgently needed to inform international policy.
authors.affiliation: Centre for Infectious Disease Research in Zambia, Plot 1275 Lubutu Road, Lusaka, Zambia. cantrell@uab.edu
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Cantrell
authors.forename: Moses
authors.initials: M
authors.lastname: Sinkala
authors.forename: Karen
authors.initials: K
authors.lastname: Megazinni
authors.forename: Sibi
authors.initials: S
authors.lastname: Lawson-Marriott
authors.forename: Sierra
authors.initials: S
authors.lastname: Washington
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
authors.forename: Bushimbwa
authors.initials: B
authors.lastname: Tambatamba-Chapula
authors.forename: Jens
authors.initials: J
authors.lastname: Levy
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Stringer
authors.forename: Lloyd
authors.initials: L
authors.lastname: Mulenga
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer