title: Food insecurity, mental health and quality of life among people living with HIV commencing antiretroviral treatment in Ethiopia: a cross-sectional study.
abstract: BACKGROUND
  Studies from high-income settings show that both food insecurity and common mental disorders (CMDs) are associated with lower quality of life among people living with HIV (PLHIV). However, there is limited research among PLHIV in sub-Saharan Africa. In this study we tested the hypothesis that food insecurity and CMDs would be associated with poorer quality of life of PLHIV in Ethiopia.
  
  
  METHODS
  A cross-sectional study was carried out with 348 PLHIV who were initiating antiretroviral therapy recruited from two primary care centers and a tertiary Hospital in southwest Ethiopia. Food insecurity, CMD, and quality of life were measured using instruments adapted and validated in Ethiopia (Household Food Insecurity Access Scale, Kessler-6, and WHOQOL-HIV-BREF-ETH, respectively). Multiple linear regression analysis was used to identify factors associated with quality of life after adjusting for confounders.
  
  
  RESULTS
  The prevalence of severe household food insecurity among PLHIV was 38.7 %. After adjusting for confounders, severe food insecurity (β = -3.24, 95 % CI: -6.19; -0.29) and higher levels of CMD symptoms (β = -1.72 for each 1 point increase, 95 % CI: -1.94; -1.49) were associated with lower quality of life. Other factors associated with lower quality of life were advanced HIV disease (β = -3.80, 95 % CI: -6.18; -1.42), and being underweight (BMI = 17.0 - 18.5 kg/m(2)) (β = -3.45, 95 % CI: -6.18; -0.71). Owning more household assets was associated with higher quality of life (β = 0.99 for owning one more asset, 95 % CI: 0.09; 1.89).
  
  
  CONCLUSIONS
  Poor mental health and food insecurity are associated with lower quality of life in PLHIV. There is a need for longitudinal studies to elucidate the pathways linking CMD, food insecurity and quality of life.
authors.affiliation: Department of Psychiatry, College of Health Sciences, Jimma University, Jimma, Ethiopia. tesmarkos@yahoo.com.|Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. tesmarkos@yahoo.com.
authors.forename: Markos
authors.initials: M
authors.lastname: Tesfaye
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. pernille.kaestel@gmail.com.
authors.forename: Pernille
authors.initials: P
authors.lastname: Kaestel
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. mfo@cochrane.dk.
authors.forename: Mette Frahm
authors.initials: MF
authors.lastname: Olsen
authors.affiliation: Department of Pediatrics and Child Health, College of Health Sciences, Jimma University, Jimma, Ethiopia. tsinuel.girma@ju.edu.et.
authors.forename: Tsinuel
authors.initials: T
authors.lastname: Girma
authors.affiliation: Department of Internal Medicine, College of Health Sciences, Jimma University, Jimma, Ethiopia. danielyilmab@gmail.com.
authors.forename: Daniel
authors.initials: D
authors.lastname: Yilma
authors.affiliation: Department of Medical Laboratory Sciences & Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia. alemseged.abdissa@ju.edu.et.
authors.forename: Alemseged
authors.initials: A
authors.lastname: Abdissa
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. ritz@nexs.ku.dk.
authors.forename: Christian
authors.initials: C
authors.lastname: Ritz
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, UK. m.prince@kcl.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.affiliation: Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark. hfr@nexs.ku.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
authors.affiliation: Centre for Global Mental Health, Institute of Psychiatry, King's College London, London, UK. charlotte.hanlon@kcl.ac.uk.|Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. charlotte.hanlon@kcl.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*
chemical_list: D044966:Anti-Retroviral Agents