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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda
PLoS ONE, Volume 5, No. 4, Article e10340, Year 2010
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Description
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. © 2010 Weiser et al.
Authors & Co-Authors
Weiser, Sheri D.
United States, San Francisco
San Francisco General Hospital and Trauma Center
United States, San Francisco
Ucsf Center for Aids Prevention Studies
Tuller, David M.
United States, Berkeley
University of California, Berkeley
Frongillo, Edward A.
United States, Columbia
University of South Carolina
Senkungu, Jude Kimbowa
Uganda, Mbarara
Mbarara University of Science and Technology
Mukiibi, Nozmu
Uganda, Mbarara
Mbarara University of Science and Technology
Bangsberg, David R.
Uganda, Mbarara
Mbarara University of Science and Technology
United States, Boston
Massachusetts General Hospital
United States, Cambridge
Harvard Initiative for Global Health
Statistics
Citations: 291
Authors: 6
Affiliations: 7
Identifiers
Doi:
10.1371/journal.pone.0010340
e-ISSN:
19326203
Research Areas
Food Security
Infectious Diseases
Study Design
Grounded Theory
Study Approach
Qualitative
Study Locations
Uganda
Participants Gender
Male
Female