School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Front Public Health. 2024 Jul 22;12:1380958. doi: 10.3389/fpubh.2024.1380958. eCollection 2024.
BACKGROUND: Food insecurity plays a crucial role in predicting the spread of HIV due to the adverse effects of coping mechanisms adopted to mitigate it. However, there is a scarcity of context-specific evidence regarding food insecurity among HIV-infected adults. Therefore, this study aimed to assess the context-specific magnitude of food insecurity and associated factors among adults receiving antiretroviral therapy (ART) in health facilities in the North Shewa Zone, Ethiopia, ultimately contributing to the achievement of the 95-95-95 HIV treatment target in the local context. METHODS: A multi-facility cross-sectional study was conducted among 865 HIV-infected adults receiving ART and being followed up for their treatment. We included health facilities that provide ART, including four hospitals and six health centers. A log-binomial regression model was fitted to identify the association between food insecurity and independent variables. Adjusted prevalence ratios (APRs) with a 95% confidence interval were computed to measure the strength of the association. RESULTS: In this study, 290 (33.7, 95% CI: 30.60, 36.91) of the HIV-infected adults studied had food insecurity during their treatment and follow-up, of which 152 (52.41, 95% CI: 46.64, 58.13) and 110 (37.93%, CI: 32.50, 43.68) of them were found to have severe and moderate forms of food insecurity, respectively. We found that being younger (APR = 2.27, 95% CI: 1.12, 4.60), being female (APR = 1.87, 95% CI: 1.03, 3.39), lacking formal education (APR = 10.79, 95% CI: 14.74, 24.58), having lower educational status (APR = 5.99, 95% CI: 2.65, 13.54), being a daily laborer (APR = 6.90, 95% CI: 2.28, 20.85), having low monthly income (APR = 1.89, 95% CI: 1.11, 3.22), advanced WHO clinical stage (APR = 2.34, 95% CI: 1.08, 5.10), and receiving ART for less than 4 years (AOR = 2.28, 95% CI: 1.09, 4.74) were significantly associated with a high proportion of food insecurity among HIV-infected adults. CONCLUSION: The magnitude of food insecurity among HIV-infected adults receiving ART was high, with an extremely high magnitude of severe food insecurity. The finding suggests the need for culture- and context-specific nutritional interventions to address the gender dynamics of food insecurity, attention to the early stage of ART, and the integration of strategies to improve educational status and enhance income-generation activities of HIV-infected adults. This requires an emphasis on the link between food insecurity and HIV in Ethiopia's national food and nutrition policy.
背景：由于应对食品不安全问题的应对机制会产生不良影响，食品不安全在预测 HIV 传播方面起着至关重要的作用。然而，针对 HIV 感染者中食品不安全问题的具体情况，相关证据仍然匮乏。因此，本研究旨在评估埃塞俄比亚北谢瓦地区接受抗逆转录病毒疗法（ART）的 HIV 感染者中具体的食品不安全程度及其相关因素，最终有助于实现当地 95-95-95 HIV 治疗目标。
方法：这是一项在北谢瓦地区接受 ART 治疗和随访的 865 名 HIV 感染者中开展的多机构横断面研究。我们纳入了提供 ART 的医疗机构，包括四家医院和六家医疗中心。采用对数二项回归模型来确定食品不安全与自变量之间的关联。使用调整后的患病率比（APR）及其 95%置信区间（CI）来衡量关联的强度。
结果：在这项研究中，290 名（33.7%，95%CI：30.60%，36.91%）HIV 感染者在治疗和随访期间存在食品不安全问题，其中 152 名（52.41%，95%CI：46.64%，58.13%）和 110 名（37.93%，95%CI：32.50%，43.68%）分别患有严重和中度形式的食品不安全。我们发现，年龄较小（APR=2.27，95%CI：1.12，4.60）、女性（APR=1.87，95%CI：1.03，3.39）、缺乏正规教育（APR=10.79，95%CI：14.74%，24.58%）、教育程度较低（APR=5.99，95%CI：2.65%，13.54%）、从事体力劳动（APR=6.90，95%CI：2.28%，20.85%）、月收入较低（APR=1.89，95%CI：1.11%，3.22%）、较高的世界卫生组织临床分期（APR=2.34，95%CI：1.08%，5.10%）和接受 ART 治疗不足 4 年（AOR=2.28，95%CI：1.09%，4.74%）与 HIV 感染者中食品不安全的高比例显著相关。
结论：接受 ART 治疗的 HIV 感染者中食品不安全的程度较高，严重食品不安全的程度极高。这一发现表明，需要采取特定文化和背景的营养干预措施，解决食品不安全问题中的性别动态问题，关注 ART 的早期阶段，并整合提高 HIV 感染者教育程度和增加收入来源的策略。这需要在埃塞俄比亚的国家食品和营养政策中强调食品不安全和 HIV 之间的联系。
J Am Geriatr Soc. 2021-4
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