A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia.
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.
Cantrell
Ronald A
RA
Centre for Infectious Disease Research in Zambia, Plot 1275 Lubutu Road, Lusaka, Zambia. cantrell@uab.edu
Sinkala
Moses
M
Megazinni
Karen
K
Lawson-Marriott
Sibi
S
Washington
Sierra
S
Chi
Benjamin H
BH
Tambatamba-Chapula
Bushimbwa
B
Levy
Jens
J
Stringer
Elizabeth M
EM
Mulenga
Lloyd
L
Stringer
Jeffrey S A
JS