Food Insecurity as a Barrier to Sustained Antiretroviral Therapy Adherence in Uganda

Dados Bibliográficos

ID23346367
AutoresSheri D Weiser (0000-0002-7807-4072, San Francisco General Hospital, autor correspondente), David M Tuller (University of California, Berkeley), Edward A Frongillo (0000-0002-8265-9815, University of South Carolina), Jude Senkungu (Mbarara University of Science and Technology), Nozmu Mukiibi (Mbarara University of Science and Technology), David R Bangsberg (0000-0002-6352-8908, Harvard University)
EditoresKoen Peeters Grietens (0000-0001-6570-9887)
Ano2010
Volume5
Fascículo4
Páginase10340
Data de publicação2010-04-28
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoPLoS ONE (JOURNAL)
Identificadores do periódicoISSN: 1932-6203 • E-ISSN: 1932-6203
EditoraPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pone.0010340
PMID20442769
PMCIDPMC2860981
OpenAlexW2007374658
IdiomaEN
Citações recebidas92
Referências citadas19

BACKGROUND: Food insecurity is emerging as an important barrier to antiretroviral (ARV) adherence in sub-Saharan Africa and elsewhere, but little is known about the mechanisms through which food insecurity leads to ARV non-adherence and treatment interruptions. METHODOLOGY: We conducted in-depth, open-ended interviews with 47 individuals (30 women, 17 men) living with HIV/AIDS recruited from AIDS treatment programs in Mbarara and Kampala, Uganda to understand how food insecurity interferes with ARV therapy regimens. Interviews were transcribed, coded for key themes, and analyzed using grounded theory. FINDINGS: Food insecurity was common and an important barrier to accessing medical care and ARV adherence. Five mechanisms emerged for how food insecurity can contribute to ARV non-adherence and treatment interruptions or to postponing ARV initiation: 1) ARVs increased appetite and led to intolerable hunger in the absence of food; 2) Side effects of ARVs were exacerbated in the absence of food; 3) Participants believed they should skip doses or not start on ARVs at all if they could not afford the added nutritional burden; 4) Competing demands between costs of food and medical expenses led people either to default from treatment, or to give up food and wages to get medications; 5) While working for food for long days in the fields, participants sometimes forgot medication doses. Despite these obstacles, many participants still reported high ARV adherence and exceptional motivation to continue therapy. CONCLUSIONS: While reports from sub-Saharan Africa show excellent adherence to ARVs, concerns remain that these successes are not sustainable in the presence of widespread poverty and food insecurity. We provide further evidence on how food insecurity can compromise sustained ARV therapy in a resource-limited setting. Addressing food insecurity as part of emerging ARV treatment programs is critical for their long-term success.

Agriculture · Antiretroviral therapy · Economic growth · Environmental health · Family medicine · Food insecurity · Food security · Grounded theory · Human immunodeficiency virus (HIV) · Poverty · Qualitative research · Viral load · Child Nutrition and Water Access · Food Security and Health in Diverse Populations · HIV/AIDS Research and Interventions · Medicine