title: Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting.
abstract: OBJECTIVE
  We undertook a longitudinal study in rural Uganda to understand the association of food insecurity with morbidity and patterns of healthcare utilization among HIV-infected individuals enrolled in an antiretroviral therapy program.
  
  
  METHODS
  Longitudinal cohort study.
  
  
  METHODS
  Participants were enrolled from the Uganda AIDS Rural Treatment Outcomes cohort, and underwent quarterly structured interviews and blood draws. The primary predictor was food insecurity measured by the validated Household Food Insecurity Access Scale. Primary outcomes included health-related quality of life measured by the validated Medical Outcomes Study-HIV Physical Health Summary (PHS), incident self-reported opportunistic infections, number of hospitalizations, and missed clinic visits. To estimate model parameters, we used the method of generalized estimating equations, adjusting for sociodemographic and clinical variables. Explanatory variables were lagged by 3 months to strengthen causal interpretations.
  
  
  RESULTS
  Beginning in May 2007, 458 persons were followed for a median of 2.07 years, and 40% were severely food insecure at baseline. Severe food insecurity was associated with worse PHS, opportunistic infections, and increased hospitalizations (results were similar in concurrent and lagged models). Mild/moderate food insecurity was associated with missed clinic visits in concurrent models, whereas in lagged models, severe food insecurity was associated with reduced odds of missed clinic visits.
  
  
  CONCLUSIONS
  Based on the negative impact of food insecurity on morbidity and patterns of healthcare utilization among HIV-infected individuals, policies and programs that address food insecurity should be a critical component of HIV treatment programs worldwide.
authors: Division of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco, 94143, USA. Sheri.Weiser@ucsf.edu
authors: Sheri D
authors: SD
authors: Weiser
authors: Alexander C
authors: AC
authors: Tsai
authors: Reshma
authors: R
authors: Gupta
authors: Edward A
authors: EA
authors: Frongillo
authors: Annet
authors: A
authors: Kawuma
authors: Jude
authors: J
authors: Senkungu
authors: Peter W
authors: PW
authors: Hunt
authors: Nneka I
authors: NI
authors: Emenyonu
authors: Jennifer E
authors: JE
authors: Mattson
authors: Jeffrey N
authors: JN
authors: Martin
authors: David R
authors: DR
authors: Bangsberg
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology; D000328:Adult; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005523:Food Supply / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D015497:HIV-1 / Q000302:isolation & purification*; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009017:Morbidity; D010349:Patient Compliance; D011788:Quality of Life; D012367:RNA, Viral / Q000302:isolation & purification; D012423:Rural Health; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load
chemical_list: D012367:RNA, Viral