title: Role of antiretroviral therapy in improving food security among patients initiating HIV treatment and care.
abstract: OBJECTIVE
  Although the physical health benefits of HIV antiretroviral therapy (ART) are well documented, the socioeconomic benefits are still being established. Few studies have examined the effects of ART on food insecurity, although studies suggest there may be a benefit via improved health and ability to work.
  
  
  METHODS
  Twelve-month prospective cohort study of 602 treatment-naive patients initiating clinical care in Uganda.
  
  
  METHODS
  Longitudinal multivariate logistic regression was used to investigate the effect of ART on food insecurity compared to HIV care without ART. A staged regression approach was used to explore pathways through which ART may affect food insecurity.
  
  
  RESULTS
  Food insecurity decreased significantly for both the ART and non-ART groups over time, with the ART group experiencing greater reductions by the end of the study. ART remained a significant predictor of reduction in food insecurity over time after controlling for baseline differences in the regression model (odds ratio 0.642; P < 0.01). Improvements in work and mental health status were identified as potential pathways through which ART may improve food security.
  
  
  CONCLUSIONS
  Taken together with the well known benefits of food security on ART adherence, treatment retention and clinical outcomes in resource-poor settings, our results suggest that a positive feedback loop of improved functioning and productivity could result from the interaction between food security and ART. Policymakers could leverage this positive cycle by strengthening mental health support and promoting sustainable food security interventions as part of HIV treatment programs.
authors.affiliation: Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, USA. kpalar@ucla.edu
authors.forename: Kartika
authors.initials: K
authors.lastname: Palar
authors.forename: Glenn
authors.initials: G
authors.lastname: Wagner
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ghosh-Dastidar
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D015331:Cohort Studies; D004651:Employment; D005260:Female; D005523:Food Supply / Q000191:economics / Q000706:statistics & numerical data; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011050:Policy Making; D011446:Prospective Studies; D012944:Social Support; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents