Background: Adherence to Antiretroviral Therapy (ART) is key to viral suppression for better health outcomes among HIV-infected individuals. While predictors of adherence to ART have been notably studied among the general population, little is said about the effect of food security especially for key and vulnerable populations, possibly due to lack of appropriate data. This analysis hypothesizes that food insecurity negatively affects adherence to ART among HIV positive caregivers of orphaned and vulnerable children (OVC) in Tanzania.
Methods: Data come from a community-based, USAID-funded Kizazi Kipya project that aims at increasing uptake of HIV/AIDS services by orphaned and vulnerable children (OVC) and their caregivers in Tanzania. HIV positive caregivers who were served by the project during January-July 2017, and reported that they are on ART were included. Using Stata, random-effects logistic regression model was fitted, with adherence to ART being the dependent variable and food security the main independent variable. ART adherence was considered as not having missed any ART dose in the past 30 days.
Results: The analysis included 12,217 HIV positive caregivers who were on ART. 72.1% were females and 27.9% were males. 20.5% of the caregivers were in food insecure households. Overall 91.1% of the caregivers reported being adherent to ART. Adherence to ART declined to 86.7% among food insecure caregivers, while so was as high as 92.4% among food secure caregivers (Figure 1), and the difference was statistically significant (p< 0.001). Multivariate analysis in Table 1 showed that the odds of being adherent to ART was significantly 35% lower among food insecure caregivers compared to their food secure counterparts (OR = 0.65, 95% CI 0.53-0.79, p< 0.001). This observation was adjusted for caregiver sex, marital status, education, family size, place of residence, health insurance ownership, and clustering at ward level.
Conclusions: Food insecurity is a significant barrier to ART adherence among caregivers of OVC in Tanzania. This suggests that, to improve adherence to ART among caregivers of OVC, nutrition and/or food security interventions are necessary among others.