Abstract
Food insecurity and drug use are closely connected in the context of poverty, and both have been suggested to interfere with HIV medication adherence among people living with HIV/AIDS (PLWH). Yet the potential interaction between the two factors on adherence has not been examined. For this study we collected longitudinal data on HIV medication adherence among PLWH in Atlanta, GA, to assess a possible synergistic effect between the two factors on HIV medication adherence. People informed about the study came to the research site and completed an audio computer-assisted self-interview and instructions for pill counting. Over the next 5 weeks participants received three unscheduled follow-up phone assessments conducted 2 weeks apart to collect pill counts of their HIV medication. The prevalence of food insecurity was 60 % (488) and that of drug use was 33 % (274) in the sample of 809 participants. Among 770 participants who completed follow-up phone assessments, both food insecurity and drug use were associated with HIV medication adherence after adjusting for socio-demographic characteristics. The negative association between drug use and adherence persisted after further adjusting for health-related characteristics. Moreover, drug use appeared to moderate the effect of food insufficiency on adherence, with drug users who were food insufficient being the least likely to achieve 85 % adherence. Results from the current study demonstrate a synergism between food insecurity and drug use that may impede adherence among PLWH. The findings imply that the disruptive effects of food insecurity and drug use on adherence are likely to be intensified with the presence of each other, and encourage interventions to address the problem of HIV medication adherence from a multi-faceted perspective that takes into account detrimental combination of problem factors.
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References
Alcabes, P., Schoenbaum, E. E., & Klein, R. S. (1993). Correlates of the rate of decline of CD4+ lymphocytes among injection drug users infected with the human immunodeficiency virus. American Journal of Epidemiology, 137, 989–1000.
Anema, A., Chan, K., Chen, Y., Weiser, S., Montaner, J. S., & Hogg, R. S. (2013). Relationship between food insecurity and mortality among HIV-positive injection drug users receiving antiretroviral therapy in British Columbia, Canada. PLoS ONE, 8, e61277. doi:10.1371/journal.pone.0061277
Anema, A., Vogenthaler, N., Frongillo, E. A., Kadiyala, S., & Weiser, S. D. (2009). Food insecurity and HIV/AIDS: Current knowledge, gaps, and research priorities. Current HIV/AIDS Reports, 6, 224–231.
Anema, A., Wood, E., Weiser, S. D., Qi, J., Montaner, J. S., & Kerr, T. (2010). Hunger and associated harms among injection drug users in an urban Canadian setting. Substance Abuse Treatment, Prevention, and Policy, 5, 20. doi:10.1186/1747-597X-5-20
Antoniou, T., & Tseng, A. L. (2002). Interactions between recreational drugs and antiretroviral agents. Annals of Pharmacotherapy, 36, 1598–1613.
Au, J. T., Kayitenkore, K., Shutes, E., Karita, E., Peters, P. J., Tichacek, A., & Allen, S. A. (2006). Access to adequate nutrition is a major potential obstacle to antiretroviral adherence among HIV-infected individuals in Rwanda. AIDS, 20, 2116–2118. doi:10.1097/01.aids.0000247580.16073.1b
Bangsberg, D. R., Kroetz, D. L., & Deeks, S. G. (2007). Adherence–resistance relationships to combination HIV antiretroviral therapy. Current HIV/AIDS Reports, 4, 65–72.
Barclay, T. R., Hinkin, C. H., Castellon, S. A., Mason, K. I., Reinhard, M. J., Marion, S. D., … & Durvasula, R. S. (2007). Age-associated predictors of medication adherence in HIV-positive adults: Health beliefs, self-efficacy, and neurocognitive status. Health Psychology, 2, 40–49. doi:10.1037/0278-6133.26.1.40
Bartlett, J. A. (2002). Addressing the challenges of adherence. Journal of Acquired Immune Deficiency Syndromes, 29, S2–10.
Campa, A., Yang, Z., Lai, S., Xue, L., Phillips, J. C., Sales, S., … & Baum, M. K. (2005). HIV-related wasting in HIV-infected drug users in the era of highly active antiretroviral therapy. Clinical Infectious Diseases, 41, 1179–1185. doi:10.1086/444499
Carrieri, M. P., Villes, V., Raffi, F., Protopopescu, C., Preau, M., Salmon, D., … & Spire, B. (2007). Self-reported side-effects of anti-retroviral treatment among IDUs: a 7-year longitudinal study (APROCO-COPILOTE COHORT ANRS CO-8). International Journal of Drug Policy, 18, 288-295
Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for measurement of food access: Indicator guide. Retrieved June 1, 2014.
Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., … & Team, H. S. (2011). Prevention of HIV-1 infection with early antiretroviral therapy. The New England Journal of Medicine, 365, 493–505. doi:10.1056/NEJMoa1105243
Ensoli, F., & Sirianni, M. C. (2002). HIV/HCV co-infection: Clinical and therapeutic challenges. AIDS, 16, 1419–1420.
Hadland, S. E., Milloy, M. J., Kerr, T., Zhang, R., Guillemi, S., Hogg, R. S., … & Wood, E. (2012). Young age predicts poor antiretroviral adherence and viral load suppression among injection drug users. AIDS Patient Care STDS, 26, 274–280. doi:10.1089/apc.2011.0196
Hendricks, K., & Gorbach, S. (2009). Nutrition issues in chronic drug users living with HIV infection. Addiction Science and Clinical Practice, 5, 16–23.
Himmelgreen, D. A., Perez-Escamilla, R., Segura-Millan, S., Romero-Daza, N., Tanasescu, M., & Singer, M. (1998). A comparison of the nutritional status and food security of drug-using and non-drug-using Hispanic women in Hartford, Connecticut. American Journal of Physical Anthropology, 107, 351–361. doi:10.1002/(SICI)1096-8644(199811)107:3<351:AID-AJPA10>3.0.CO;2-7
Hinkin, C. H., Barclay, T. R., Castellon, S. A., Levine, A. J., Durvasula, R. S., Marion, S. D., … & Longshore, D. (2007). Drug use and medication adherence among HIV-1 infected individuals. AIDS Behavior, 11, 185–194. doi:10.1007/s10461-006-9152-0
Kalichman, S. C., Amaral, C. M., Cherry, C., Flanagan, J., Pope, H., Eaton, L., … & Schinazi, R. F. (2008). Monitoring medication adherence by unannounced pill counts conducted by telephone: Reliability and criterion-related validity. HIV Clinical Trials, 9, 298–308. doi:10.1310/hct0905-298
Kalichman, S. C., Pellowski, J., Kalichman, M. O., Cherry, C., Detorio, M., Caliendo, A. M., & Schinazi, R. F. (2011). Food insufficiency and medication adherence among people living with HIV/AIDS in urban and peri-urban settings. Prevention Science, 12, 324–332. doi:10.1007/s11121-011-0222-9
Leaver, C. A., Bargh, G., Dunn, J. R., & Hwang, S. W. (2007). The effects of housing status on health-related outcomes in people living with HIV: A systematic review of the literature. AIDS Behavior, 11, 85–100. doi:10.1007/s10461-007-9246-3
Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., & Kelley, M. E. (2000). An empirical investigation of the factor structure of the AUDIT. Psychological Assessment, 12, 346–353.
Miller, C. L., Bangsberg, D. R., Tuller, D. M., Senkungu, J., Kawuma, A., Frongillo, E. A., & Weiser, S. D. (2011). Food insecurity and sexual risk in an HIV endemic community in Uganda. AIDS Behavior, 15, 1512–1519. doi:10.1007/s10461-010-9693-0
Musumari, P. M., Wouters, E., Kayembe, P. K., Kiumbu Nzita, M., Mbikayi, S. M., Suguimoto, S. P., … & Kihara, M. (2014). Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: A cross-sectional study. PLoS One, 9, e85327. doi:10.1371/journal.pone.0085327
Normen, L., Chan, K., Braitstein, P., Anema, A., Bondy, G., Montaner, J. S., & Hogg, R. S. (2005). Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada. Journal of Nutrition, 135, 820–825.
Pan, W. (2001). Akaike’s information criterion in generalized estimating equations. Biometrics, 57, 120–125.
Peretti-Watel, P., Spire, B., Schiltz, M. A., Bouhnik, A. D., Heard, I., Lert, F., … & Group, V. (2006). Vulnerability, unsafe sex and non-adherence to HAART: Evidence from a large sample of French HIV/AIDS outpatients. Social Science and Medicine, 62, 2420–2433. doi:10.1016/j.socscimed.2005.10.020
Piot, P., Greener, R., & Russell, S. (2007). Squaring the circle: AIDS, poverty, and human development. PLoS Medicine, 4, 1571–1575. doi:10.1371/journal.pmed.0040314
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Romero-Daza, N., Himmelgreen, D. A., Pérez-Escamilla, R., Segura-Millán, S., & Singer, M. (1999). Food habits of drug-using Puerto Rican women in inner-city Hartford. Medical Anthropology: Cross-Cultural Studies in Health and Illness, 18, 281–298.
Rose, A. M., Sinka, K., Watson, J. M., Mortimer, J. Y., & Charlett, A. (2002). An estimate of the contribution of HIV infection to the recent rise in tuberculosis in England and Wales. Thorax, 57, 442–445.
Sethi, A. K., Celentano, D. D., Gange, S. J., Moore, R. D., & Gallant, J. E. (2003). Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clinical Infectious Diseases, 37, 1112–1118. doi:10.1086/378301
Shannon, K., Kerr, T., Milloy, M. J., Anema, A., Zhang, R., Montaner, J. S., & Wood, E. (2011). Severe food insecurity is associated with elevated unprotected sex among HIV-seropositive injection drug users independent of HAART use. AIDS, 25, 2037–2042. doi:10.1097/QAD.0b013e32834b35c9
Singer, M., & Clair, S. (2003). Syndemics and public health: Reconceptualizing disease in bio-social context. Medical Anthropology Quarterly, 17, 423–441.
StataCorp. (2011). Stata Statistical Software: Release 12. College Station, TX: StataCorp LP.
Strike, C., Rudzinski, K., Patterson, J., & Millson, M. (2012). Frequent food insecurity among injection drug users: Correlates and concerns. BMC Public Health, 12, 1058. doi:10.1186/1471-2458-12-1058
USDA. (2006). Food Insecurity and Hunger in the United States: An assessment of the measure. Washington: National Academies Press.
Weiser, S. D., Bangsberg, D. R., Kegeles, S., Ragland, K., Kushel, M. B., & Frongillo, E. A. (2009a). Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS Behavior, 13, 841–848. doi:10.1007/s10461-009-9597-z
Weiser, S. D., Fernandes, K. A., Brandson, E. K., Lima, V. D., Anema, A., Bangsberg, D. R., … & Hogg, R. S. (2009). The association between food insecurity and mortality among HIV-infected individuals on HAART. Journal of Acquired Immune Deficiency Syndromes, 52, 342–349. doi:10.1097/QAI.0b013e3181b627c2
Weiser, S. D., Frongillo, E. A., Ragland, K., Hogg, R. S., Riley, E. D., & Bangsberg, D. R. (2009c). Food insecurity is associated with incomplete HIV RNA suppression among homeless and marginally housed HIV-infected individuals in San Francisco. Journal of General Internal Medicine, 24, 14–20. doi:10.1007/s11606-008-0824-5
Weiser, S. D., Young, S. L., Cohen, C. R., Kushel, M. B., Tsai, A. C., Tien, P. C., … & Bangsberg, D. R. (2011). Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. The American Journal of Clinical Nutrition, 94, 1729S–1739S. doi:10.3945/ajcn.111.012070
Wood, E., Hogg, R. S., Yip, B., Moore, D., Harrigan, P. R., & Montaner, J. S. (2006). Impact of baseline viral load and adherence on survival of HIV-infected adults with baseline CD4 cell counts > or = 200 cells/microl. AIDS, 20, 1117–1123. doi:10.1097/01.aids.0000226951.49353.ed
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This project was supported by National Institute of Drug Abuse Grant R01-DA017399.
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Yiyun Chen and Seth C. Kalichman declare that they have no conflict of interest.
Human and animal rights and Informed Consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
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Chen, Y., Kalichman, S.C. Synergistic effects of food insecurity and drug use on medication adherence among people living with HIV infection. J Behav Med 38, 397–406 (2015). https://doi.org/10.1007/s10865-014-9612-3
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DOI: https://doi.org/10.1007/s10865-014-9612-3