Background: Viral suppression in HIV-infected pregnant women is essential to elimination of mother-to-child transmission. Limited data exist on the impact of food insecurity on viral suppression in pregnant women. We evaluated prevalence of food insecurity and its association with viral suppression among pregnant women in Kenya.
Methods: We conducted a cross-sectional analysis of enrollment data from a trial evaluating mHealth strategies to improve ART adherence (Mobile WAChX, NCT02400671). Participants were age ≥14, HIV-infected, pregnant and had daily access to a mobile phone. Participants were recruited from 6 public MCH clinics in Nairobi and Nyanza region. Self-report questionnaires and plasma viral load (VL) were collected. Viral suppression was defined as VL < 1000 copies/ml among women on ART ≥6 months. Food insecurity, depression and social support were assessed using the Household Food Insecurity Access Scale (HFIAS), PHQ9 and MOS respectively. HFIAS scores were categorized per instrument guidelines and dichotomized into secure/mildly-insecure versus moderately/severely-insecure. Correlates of food insecurity were assessed by univariable Poisson regression with robust standard errors.
Results: Eight-hundred twenty-five women were enrolled, of whom 820 had complete data for this analysis. Median age was 27 (IQR 23-31), gestational age was 24.3 weeks (18.3-29.6), monthly income was 8000 KSh (~80 $US). Women had a median of 2 (1-2) living children and 695 (84.3%) were married/cohabiting. Overall, 336 (41.0%) were food secure, 72 (8.8%) mildly insecure, 179 (21.8%) moderately insecure, and 233 (28.4%) severely insecure. Prevalence of moderate/severe insecurity was associated with older age (RR 1.02, 95%CI 1.01-1.03, per year), lower income (RR 0.95, 0.94-0.97, per $10 increase), more children (RR 1.17, 1.12-1.22, per child), ≥mild depression (RR 1.64, 1.44-1.86), and lower social support (RR 0.81, 0.76-0.86, per 1-point increase on 4-point scale). Of 442 women on ART ≥6 months, 385 (87.1%) were virally suppressed. Moderate/severe food insecurity was associated with unsuppressed VL (RR 1.88, 1.10-3.22).
Conclusions: Our findings suggest that approximately half of pregnant HIV-infected women in Kenya experienced moderate or severe food insecurity. Food insecurity was significantly associated with older age, lower income, more children, lower social support, depression and unsuppressed VL. Nutrition assistance may be useful to support viral suppression in pregnant women.

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