aDivision of HIV/AIDS, San Francisco General Hospital, University of California, San Francisco (UCSF), San Francisco bDepartment of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California cDepartment of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina dMassachusetts General Hospital Center for Global Health, Boston, Massachusetts, USA eMbarara University of Science and Technology; Mbarara, Uganda fUnited Nations World Food Programme, Rome, Italy gDepartment of Epidemiology and Biostatistics, UCSF, San Francisco, California hRagon Institute of MGH, MIT and Harvard University iDepartment of Global Health and Social Equity, Harvard Medical School jDepartment of Global Health and Populations, Harvard School of Public Health, Boston, Massachusetts, USA.
AIDS. 2014 Jan 2;28(1):115-20. doi: 10.1097/01.aids.0000433238.93986.35.
Food insecurity is a potentially important barrier to the success of antiretroviral therapy (ART) programs in resource-limited settings. We undertook a longitudinal study in rural Uganda to estimate the associations between food insecurity and HIV treatment outcomes.
Longitudinal cohort study.
Participants were from the Uganda AIDS Rural Treatment Outcomes study and were followed quarterly for blood draws and structured interviews. We measured food insecurity with the validated Household Food Insecurity Access Scale. Our primary outcomes were: ART nonadherence (adherence <90%) measured by visual analog scale; incomplete viral load suppression (>400 copies/ml); and low CD4 T-cell count (<350 cells/μl). We used generalized estimating equations to estimate the associations, adjusting for socio-demographic and clinical variables.
We followed 438 participants for a median of 33 months; 78.5% were food insecure at baseline. In adjusted analyses, food insecurity was associated with higher odds of ART nonadherence [adjusted odds ratio (AOR) 1.56, 95% confidence interval (CI) 1.10-2.20, P < 0.05], incomplete viral suppression (AOR 1.52, 95% CI 1.18-1.96, P < 0.01), and CD4 T-cell count less than 350 (AOR 1.47, 95% CI 1.24-1.74, P < 0.01). Adding adherence as a covariate to the latter two models removed the association between food insecurity and viral suppression, but not between food insecurity and CD4 T-cell count.
Food insecurity is longitudinally associated with poor HIV outcomes in rural Uganda. Intervention research is needed to determine the extent to which improved food security is causally related to improved HIV outcomes and to identify the most effective policies and programs to improve food security and health.
在资源有限的环境中，食物不安全可能是抗逆转录病毒疗法（ART）项目成功的一个重要障碍。我们在乌干达农村进行了一项纵向研究，以估计食物不安全与 HIV 治疗结果之间的关联。
纵向队列研究。
参与者来自乌干达艾滋病农村治疗结果研究，并每季度进行一次血液抽取和结构化访谈。我们使用经过验证的家庭食物不安全评估量表来衡量食物不安全。我们的主要结果是：通过视觉模拟量表测量的 ART 不依从（依从性<90%）；不完全病毒载量抑制（>400 拷贝/ml）；以及低 CD4 细胞计数（<350 个/μl）。我们使用广义估计方程来估计关联，调整了社会人口统计学和临床变量。
我们对 438 名参与者进行了中位数为 33 个月的随访；基线时 78.5%的人食物不安全。在调整后的分析中，食物不安全与更高的 ART 不依从风险相关[调整后的优势比（AOR）1.56，95%置信区间（CI）1.10-2.20，P<0.05]，不完全病毒抑制（AOR 1.52，95%CI 1.18-1.96，P<0.01），以及 CD4 细胞计数低于 350 个/μl（AOR 1.47，95%CI 1.24-1.74，P<0.01）。在后两个模型中，将依从性作为协变量加入，消除了食物不安全与病毒抑制之间的关联，但未消除食物不安全与 CD4 细胞计数之间的关联。
在乌干达农村，食物不安全与 HIV 不良结局呈纵向相关。需要进行干预研究，以确定改善食物安全在多大程度上与改善 HIV 结局有关，并确定改善食物安全和健康的最有效政策和方案。
