Food Security and Antiretroviral Therapy Adherence among People Living with HIV in Lundazi District, Zambia: A Pilot Study

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  • March 21, 2019
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  • Masa, Rainier
    • Affiliation: School of Social Work
Abstract
  • Food security, or adequate access to food at all times, is critical to the health and well-being of people living with HIV (PLHIV). Research has shown that food insecurity is associated with suboptimal adherence to antiretroviral therapy (ART). Nonadherence, in turn, predicts adverse health outcomes, including higher risk of mortality. However, evidence remains limited on the prevalence, correlates and effects of food insecurity on treatment adherence, as well as appropriate strategies to improve food security in rural and resource-limited settings. This dissertation aims to: 1) expand the literature on food insecurity and ART adherence in resource-limited settings, particularly in rural communities; and 2) examine the effectiveness of an income-generating strategy to increase food security and treatment adherence among PLHIV in Lundazi District, Eastern Province, Zambia. The study sample included 101 PLHIV who were attending two health facilities in Lundazi District and participating in a pilot integrated HIV and livelihood program. Consistent with prior research, food insecurity was highly prevalent among the study sample. Ninety-three and 95 percent of the sample were food insecure at baseline and follow-up, respectively. In addition, at least 70% of the sample was severely food-insecure at both time points. In this rural sample of PLHIV, food insecurity was predicted by lack of economic security in the household. Lower income, fewer assets, and having debts were significantly associated with food insecurity. Results also indicated an inverse, albeit not statistically significant, association between food insecurity and treatment adherence. Food-insecure PLHIV were less likely to achieve optimal treatment adherence contrasted with food-secure PLHIV. Finally, participation in a livelihood program contributed to statistically significant increase in food security, as well as positive effect on treatment adherence. Findings suggest that food security can be improved using a promising intervention that targets underlying social and economic determinants of food insecurity among PLHIV. Implications of findings for social work policy, practice, and research, as well as key study limitations, are discussed.
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  • In Copyright
Advisor
  • Rounds, Kathleen
  • Chowa, Gina
  • Sherraden, Michael
  • Guo, Shenyang
  • Singh Ongechi, Kavita
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2016
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