title: Food insecurity is a barrier to prevention of mother-to-child HIV transmission services in Zimbabwe: a cross-sectional study.
abstract: BACKGROUND
  Food insecurity (FI) is the lack of physical, social, and economic access to sufficient food for dietary needs and food preferences. We examined the association between FI and women's uptake of services to prevent mother-to-child HIV transmission (MTCT) in Zimbabwe.
  
  
  METHODS
  We analyzed cross-sectional data collected in 2012 from women living in five of ten provinces. Eligible women were ≥16 years old, biological mothers of infants born 9-18 months before the interview, and were randomly selected using multi-stage cluster sampling. Women and infants were tested for HIV and interviewed about health service utilization during pregnancy, delivery, and post-partum. We assessed FI in the past four weeks using a subset of questions from the Household Food Insecurity Access Scale and classified women as living in food secure, moderately food insecure, or severely food insecure households.
  
  
  RESULTS
  The weighted population included 8,790 women. Completion of all key steps in the PMTCT cascade was reported by 49%, 45%, and 38% of women in food secure, moderately food insecure, and severely food insecure households, respectively (adjusted prevalence ratio (PRa) = 0.95, 95% confidence interval (CI): 0.90, 1.00 (moderate FI vs. food secure), PRa = 0.86, 95% CI: 0.79, 0.94 (severe FI vs. food secure)). Food insecurity was not associated with maternal or infant receipt of ART/ARV prophylaxis. However, in the unadjusted analysis, among HIV-exposed infants, 13.3% of those born to women who reported severe household food insecurity were HIV-infected compared to 8.2% of infants whose mothers reported food secure households (PR = 1.62, 95% CI: 1.04, 2.52). After adjustment for covariates, this association was attenuated (PRa = 1.42, 95% CI: 0.89, 2.26). There was no association between moderate food insecurity and MTCT in unadjusted or adjusted analyses (PRa = 0.68, 95% CI: 0.43, 1.08).
  
  
  CONCLUSIONS
  Among women with a recent birth, food insecurity is inversely associated with service utilization in the PMTCT cascade and severe household food insecurity may be positively associated with MTCT. These preliminary findings support the assessment of FI in antenatal care and integrated food and nutrition programs for pregnant women to improve maternal and child health.
authors.affiliation: University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA, 94704, USA. smccoy@berkeley.edu.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.affiliation: University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA, 94704, USA. rbuzdugan@berkeley.edu.
authors.forename: Raluca
authors.initials: R
authors.lastname: Buzdugan
authors.affiliation: Ministry of Health and Child Welfare, Mkwati Building Corner 5th Street and Livingstone Avenue, Harare, Zimbabwe. mushavia@yahoo.co.uk.
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.affiliation: Elizabeth Glaser Pediatric AIDS Foundation, 107 King George Road, Avondale, Harare, Zimbabwe. amahomva@pedaids.org.
authors.forename: Agnes
authors.initials: A
authors.lastname: Mahomva
authors.affiliation: Centre for Sexual Health and HIV Research, 9 Monmouth Rd, Avondale West, Harare, Zimbabwe. f.cowan@ucl.ac.uk.|University College London, London, UK. f.cowan@ucl.ac.uk.
authors.forename: Frances M
authors.initials: FM
authors.lastname: Cowan
authors.affiliation: University of California, 1950 Addison Avenue, Suite 202-8, Berkeley, CA, 94704, USA. nancy.padian@gmail.com.
authors.forename: Nancy S
authors.initials: NS
authors.lastname: Padian
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000635:transmission*; D006296:Health Services; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening; D009035:Mothers / Q000706:statistics & numerical data*; D009752:Nutritional Status; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents