title: Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health.
abstract: Food insecurity is associated with negative chronic health outcomes, yet few studies have examined how providing medically appropriate food assistance to food-insecure individuals may improve health outcomes in resource-rich settings. We evaluated a community-based food support intervention in the San Francisco Bay Area for people living with HIV and/or type 2 diabetes mellitus (T2DM) to determine the feasibility, acceptability, and potential impact of the intervention on nutritional, mental health, disease management, healthcare utilization, and physical health outcomes. The 6-month intervention provided meals and snacks designed to comprise 100% of daily energy requirements and meet nutritional guidelines for a healthy diet. We assessed paired outcomes at baseline and 6 months using validated measures. Paired t tests and McNemar exact tests were used with continuous and dichotomous outcomes, respectively, to compare pre-post changes. Fifty-two participants (out of 72 initiators) had both baseline and follow-up assessments, including 23 with HIV, 24 with T2DM, and 7 with both HIV and T2DM. Median food pick-up adherence was 93%. Comparing baseline to follow-up, very low food security decreased from 59.6% to 11.5% (p < 0.0001). Frequency of consumption of fats (p = 0.003) decreased, while frequency increased for fruits and vegetables (p = 0.011). Among people with diabetes, frequency of sugar consumption decreased (p = 0.006). We also observed decreased depressive symptoms (p = 0.028) and binge drinking (p = 0.008). At follow-up, fewer participants sacrificed food for healthcare (p = 0.007) or prescriptions (p = 0.046), or sacrificed healthcare for food (p = 0.029). Among people with HIV, 95% adherence to antiretroviral therapy increased from 47 to 70% (p = 0.046). Among people with T2DM, diabetes distress (p < 0.001), and perceived diabetes self-management (p = 0.007) improved. Comprehensive, medically appropriate food support is feasible and may improve multiple health outcomes for food-insecure individuals living with chronic health conditions. Future studies should formally test the impact of medically appropriate food support interventions for food-insecure populations through rigorous, randomized controlled designs.
authors.affiliation: Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA. Kartika.Palar@ucsf.edu.
authors.forename: Kartika
authors.initials: K
authors.lastname: Palar
authors.affiliation: Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Tessa
authors.initials: T
authors.lastname: Napoles
authors.affiliation: Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.|University of California Berkeley-University of California at San Francisco Joint Medical Program School of Public Health, University of California Berkeley, Berkeley, CA, USA.
authors.forename: Lee L
authors.initials: LL
authors.lastname: Hufstedler
authors.affiliation: Division of General Internal Medicine, San Francisco General Hospital, Department of Medicine, UCSF, San Francisco, CA, USA.
authors.forename: Hilary
authors.initials: H
authors.lastname: Seligman
authors.affiliation: Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Fredrick M
authors.initials: FM
authors.lastname: Hecht
authors.affiliation: Project Open Hand, San Francisco, CA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Madsen
authors.affiliation: Project Open Hand, San Francisco, CA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Ryle
authors.affiliation: Homebridge, Inc., San Francisco, CA, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Pitchford
authors.affiliation: Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
authors.affiliation: Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA.|Center for AIDS Prevention Studies, UCSF, San Francisco, CA, USA.
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000178:diet therapy*; D005260:Female; D005523:Food Supply; D015658:HIV Infections / Q000178:diet therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011795:Surveys and Questionnaires
keywords: Community-based; Diabetes; Food; Food assistance; Food security; Food support; HIV; Intervention; Medically tailored; Nutrition