Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda.
BACKGROUND
Food insecurity is emerging as an important barrier to antiretroviral (ARV) adherence in sub-Saharan Africa and elsewhere, but little is known about the mechanisms through which food insecurity leads to ARV non-adherence and treatment interruptions.


METHODS
We conducted in-depth, open-ended interviews with 47 individuals (30 women, 17 men) living with HIV/AIDS recruited from AIDS treatment programs in Mbarara and Kampala, Uganda to understand how food insecurity interferes with ARV therapy regimens. Interviews were transcribed, coded for key themes, and analyzed using grounded theory.


RESULTS
Food insecurity was common and an important barrier to accessing medical care and ARV adherence. Five mechanisms emerged for how food insecurity can contribute to ARV non-adherence and treatment interruptions or to postponing ARV initiation: 1) ARVs increased appetite and led to intolerable hunger in the absence of food; 2) Side effects of ARVs were exacerbated in the absence of food; 3) Participants believed they should skip doses or not start on ARVs at all if they could not afford the added nutritional burden; 4) Competing demands between costs of food and medical expenses led people either to default from treatment, or to give up food and wages to get medications; 5) While working for food for long days in the fields, participants sometimes forgot medication doses. Despite these obstacles, many participants still reported high ARV adherence and exceptional motivation to continue therapy.


CONCLUSIONS
While reports from sub-Saharan Africa show excellent adherence to ARVs, concerns remain that these successes are not sustainable in the presence of widespread poverty and food insecurity. We provide further evidence on how food insecurity can compromise sustained ARV therapy in a resource-limited setting. Addressing food insecurity as part of emerging ARV treatment programs is critical for their long-term success.
Weiser
Sheri D
SD
Division of HIV/AIDS, San Francisco General Hospital, San Francisco, California, United States of America. Sheri.Weiser@ucsf.edu
Tuller
David M
DM
Frongillo
Edward A
EA
Senkungu
Jude
J
Mukiibi
Nozmu
N
Bangsberg
David R
DR
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003625:Data Collection; D016527:Drug Costs; D005260:Female; D005523:Food Supply / Q000191:economics / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D006815:Hunger / Q000187:drug effects; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011203:Poverty; D014454:Uganda; D016903:Drug Monitoring
D044966:Anti-Retroviral Agents