Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.
Department of Public Health Sciences, School of Medicine and Dentistry, University of Rochester, Rochester, NY, United States.
Front Public Health. 2023 Aug 2;11:1133328. doi: 10.3389/fpubh.2023.1133328. eCollection 2023.
Attaining The Joint United Nations Programme on HIV/AIDS 95-95-95 targets to end the HIV epidemic by 2030 will require a greater understanding of the underlying mechanisms influencing care engagement among people living with HIV/AIDS (PLWHA). One such mechanism is food insecurity, defined as limited or uncertain access to food. Food insecurity has been shown to significantly impact HIV outcomes. Yet, few studies have examined the mechanisms through which food insecurity may influence these outcomes. We aimed to examine the effects of nutritional, behavioral, and mental health mechanisms through which food insecurity may impact HIV care continuum outcomes: receipt of care, retention in care, and viral suppression.
We conducted a cross-sectional study of 200 PLWHA in New York State, United States from May-August 2022. Participants were recruited using convenience sampling methods. Multivariable logistic regression models were conducted to examine the associations between food insecurity and care continuum outcomes (receipt of care, retention in care, viral suppression), adjusting for age, race, ethnicity, education, income, and marital status. Individual causal mediation analyses were conducted to assess whether behavioral, mental health, and nutritional mechanisms mediated the hypothesized associations.
The median age of participants was 30 years (IQR: 27-37 years). The majority self-identified as Black (54.0%), male (55.5%) and straight/heterosexual (63.0%). Increasing severity of food insecurity was associated with greater odds of non-retention in care (aOR: 1.35, 95% CI: 1.07, 1.70) and viral non-suppression (aOR: 1.29, 95% CI: 1.08, 1.54). For the impact of food insecurity on non-retention in care, there was an indirect relationship (natural indirect effect; NIE) mediated through Body Mass Index (BMI) (OR: 1.08, 95% CI: 1.00, 1.18). For viral non-suppression, there was an indirect relationship mediated through BMI (OR: 1.07, 95% CI: 1.00,1.16) and an indirect relationship mediated through depression (OR: 1.27, 95% CI: 1.07, 1.47).
Food insecurity was associated with greater odds of non-retention in care and viral non-suppression among PLWHA. Nutritional and mental health pathways are important mediators of these relationships. Results highlight the need for interventions to target these pathways to address food insecurity as an underlying mechanism influencing engagement in HIV care.
要实现联合国艾滋病规划署 2030 年终结艾滋病流行的 95-95-95 目标，就需要深入了解影响艾滋病毒感染者/艾滋病患者（PLWHA）参与护理的潜在机制。其中一个机制是粮食不安全，定义为获得食物的机会有限或不确定。粮食不安全已被证明会严重影响艾滋病毒的结果。然而，很少有研究探讨粮食不安全可能通过哪些机制影响这些结果。我们旨在研究营养、行为和心理健康等机制，这些机制可能通过影响粮食不安全来影响艾滋病毒护理连续体的结果：获得护理、在护理中保持、病毒抑制。
我们对 2022 年 5 月至 8 月期间美国纽约州的 200 名 PLWHA 进行了横断面研究。参与者是通过便利抽样方法招募的。多变量逻辑回归模型用于检验粮食不安全与护理连续体结果（获得护理、在护理中保持、病毒抑制）之间的关联，同时调整年龄、种族、民族、教育、收入和婚姻状况。进行了个体因果中介分析，以评估行为、心理健康和营养机制是否在假设的关联中起中介作用。
参与者的中位年龄为 30 岁（IQR：27-37 岁）。大多数人自认为是黑人（54.0%）、男性（55.5%）和异性恋者（63.0%）。粮食不安全程度的增加与非保留护理的几率增加有关（比值比：1.35，95%置信区间：1.07，1.70）和病毒未抑制（比值比：1.29，95%置信区间：1.08，1.54）。对于粮食不安全对非保留护理的影响，存在通过身体质量指数（BMI）的间接关系（自然间接效应；NIE）（比值比：1.08，95%置信区间：1.00，1.18）。对于病毒未抑制，存在通过 BMI 的间接关系（比值比：1.07，95%置信区间：1.00，1.16）和通过抑郁的间接关系（比值比：1.27，95%置信区间：1.07，1.47）。
粮食不安全与 PLWHA 中非保留护理和病毒未抑制的几率增加有关。营养和心理健康途径是这些关系的重要中介。结果强调需要采取干预措施，针对这些途径解决粮食不安全作为影响艾滋病毒护理参与的潜在机制。
