Harvard T.H. Chan School of Public Health, Department of Global Health & Population, 665 Huntington Avenue, Building 1, Room 1104, 02115, 1167 Boylston St., Apt. 12, Boston, MA, USA.
Africa Health Research Institute, KwaZulu-Natal, South Africa.
Soc Sci Med. 2018 Feb;198:175-184. doi: 10.1016/j.socscimed.2017.11.036. Epub 2017 Nov 26.
While evidence suggests that adequate nutrition contributes to the efficacy of ART, the potential causal impact of ART initiation on household food security has not been thoroughly examined. In this study, we present some of the first causal evidence of the impact of ART initiation on household food security. We employ a quasi-experimental design, regression discontinuity, over 5540 individuals from an ongoing population cohort study in KwaZulu-Natal, South Africa, by utilizing the CD4 count-based ART eligibility threshold to examine the impact of ART initiation on household food security. We find that ART initiation causes a significant increase in the probability of food insecurity in the first year, which diminishes to zero within three years of initiation. Within the first year, ART initiation was found to significantly increase the probabilities that (1) the surveyed adult had missed any food in the past month by 10.2 percentage points (coefficient = 0.102, 95%CI = [0.039, 0.166]); (2) any adult in the household had missed a meal in the past month by 15.2 percentage points (coefficient = 0.152, 95%CI = [0.073, 0.231]); and (3) any child in the household had missed a meal in the past month by 8.9 percentage points (coefficient = 0.0898, 95%CI = [0.0317, 0.148]). While we cannot definitively isolate the mechanistic pathways from ART to household food security, our results are consistent with ART affecting food security through household resource strain and patient appetite recovery. Several policies could mitigate the negative impact of ART on food security, in particular food parcels or food vouchers for ART patients in the first two years after treatment initiation.
虽然有证据表明充足的营养有助于提高抗逆转录病毒疗法（ART）的疗效，但 ART 开始治疗对家庭粮食安全的潜在因果影响尚未得到彻底研究。在本研究中，我们提供了一些关于 ART 开始治疗对家庭粮食安全影响的首批因果证据。我们采用准实验设计、回归不连续性，利用 CD4 计数为基础的 ART 资格门槛，对来自南非夸祖鲁-纳塔尔省正在进行的人群队列研究中的 5540 多名个体进行分析，以检验 ART 开始治疗对家庭粮食安全的影响。我们发现，ART 开始治疗在第一年显著增加了粮食不安全的可能性，这种影响在开始治疗三年内降至零。在第一年，ART 开始治疗被发现显著增加了以下情况的可能性：（1）过去一个月中被调查的成年人有 10.2 个百分点（系数=0.102，95%置信区间[0.039，0.166]）错过了任何食物；（2）过去一个月中家庭中的任何成年人有 15.2 个百分点（系数=0.152，95%置信区间[0.073，0.231]）错过了一顿饭；以及（3）过去一个月中家庭中的任何儿童有 8.9 个百分点（系数=0.0898，95%置信区间[0.0317，0.148]）错过了一顿饭。虽然我们无法明确确定从 ART 到家庭粮食安全的机制途径，但我们的结果与 ART 通过家庭资源紧张和患者食欲恢复来影响粮食安全的观点一致。有几项政策可以减轻 ART 对粮食安全的负面影响，特别是在治疗开始后头两年为 ART 患者提供食品包裹或食品券。
