Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study.
BACKGROUND
Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC).


RESULTS
This is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38-3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15-3.32) and decreased (AOR, 0.31; CI, 0.11-0.83) odds of non-adherence to ART.


CONCLUSIONS
Food insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa.
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Patou Masika
PM
Musumari
Department of Sociology, Research Centre for Longitudinal and Life Course Studies, University of Antwerp, Antwerp, Belgium.
Edwin
E
Wouters
Kinshasa University School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Patrick Kalambayi
PK
Kayembe
Kinshasa University School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
Modeste
M
Kiumbu Nzita
Centre Hospitalier Monkole, Kinshasa, Democratic Republic of Congo.
Samclide Mutindu
SM
Mbikayi
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
S Pilar
SP
Suguimoto
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Teeranee
T
Techasrivichien
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Bhekumusa Wellington
BW
Lukhele
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Christina
C
El-Saaidi
London School of Hygiene and Tropical Medicine, London, United Kingdom.
Peter
P
Piot
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Masako
M
Ono-Kihara
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan.
Masahiro
M
Kihara
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D015023:Democratic Republic of the Congo; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D010349:Patient Compliance
D019380:Anti-HIV Agents