Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya
Introduction The relationship between food insecurity and access to healthcare in low-resource settings remains unclear. Some studies find that food insecurity is a barrier to accessing care, while others report that food insecurity is associated with a greater need for care, leading to more care ut...
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| Format: | Article |
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BMJ Publishing Group
2024-12-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/9/12/e016721.full |
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| author | Rajesh Vedanthan Dan N Tran Juddy Wachira Catherine Kafu Marta Wilson-Barthes Omar Galárraga Sonak D Pastakia Manuel Vazquez Sanchez Jamil Said Becky Genberg Mariam Ardehali Ben Mosong |
| author_facet | Rajesh Vedanthan Dan N Tran Juddy Wachira Catherine Kafu Marta Wilson-Barthes Omar Galárraga Sonak D Pastakia Manuel Vazquez Sanchez Jamil Said Becky Genberg Mariam Ardehali Ben Mosong |
| author_sort | Rajesh Vedanthan |
| collection | DOAJ |
| description | Introduction The relationship between food insecurity and access to healthcare in low-resource settings remains unclear. Some studies find that food insecurity is a barrier to accessing care, while others report that food insecurity is associated with a greater need for care, leading to more care utilisation. We use data from the Harambee study in western Kenya to assess the association between food insecurity and difficulty accessing care among people living with HIV (PLWH) with or without comorbid non-communicable diseases (NCDs).Methods The Harambee study is a cluster randomised trial that tested the effectiveness of delivering integrated HIV and NCD care for PLWH. In this cross-sectional analysis, we examined baseline data from Harambee participants to investigate the relationship between household food insecurity and difficulty accessing care, using multivariable logistic regression models, controlling for sociodemographic factors and care satisfaction. We tested for effect measure modification by gender and household wealth and stratified analyses by NCD status.Results Among 1039 participants, 11.1% reported difficulty accessing care, and 18.9% and 51.9% of participants had moderate and severe food insecurity, respectively. Among those with difficulty accessing care, 73.9% cited transportation issues as the major barrier. Difficulty accessing care was greater with higher levels of food insecurity: among participants with low, moderate and severe food insecurity, 5.9%, 9.7% and 14.4% reported difficulty accessing care, respectively. After adjusting for confounders, severe food insecurity was independently associated with difficulty accessing care (adjusted OR=2.5, 95% CI 1.4 to 4.4). There was no statistical evidence for effect measure modification by gender or wealth.Conclusions We found that greater food insecurity was associated with greater difficulty accessing care among PLWH with or without NCDs in rural western Kenya. These findings suggest that addressing social determinants of health may be necessary when implementing integrated HIV and NCD care programmes. |
| format | Article |
| id | doaj-art-235eb0093f304f1db9f3f19cdf5d48f9 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-235eb0093f304f1db9f3f19cdf5d48f92024-12-16T07:15:08ZengBMJ Publishing GroupBMJ Global Health2059-79082024-12-0191210.1136/bmjgh-2024-016721Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western KenyaRajesh Vedanthan0Dan N Tran1Juddy Wachira2Catherine Kafu3Marta Wilson-Barthes4Omar Galárraga5Sonak D Pastakia6Manuel Vazquez Sanchez7Jamil Said8Becky Genberg9Mariam Ardehali10Ben Mosong11Population Health, New York University Grossman School of Medicine, New York, New York, USAAcademic Model Providing Access to Healthcare, Eldoret, KenyaDepartment of Behavioral Science, Moi University School of Medicine, Eldoret, Central, KenyaAcademic Model Providing Access to Healthcare, Eldoret, KenyaDepartment of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USADepartment of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USADepartment of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USAPopulation Health, New York University Grossman School of Medicine, New York, New York, USAAcademic Model Providing Access to Healthcare, Eldoret, KenyaDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USAAcademic Model Providing Access to Healthcare, Eldoret, KenyaIntroduction The relationship between food insecurity and access to healthcare in low-resource settings remains unclear. Some studies find that food insecurity is a barrier to accessing care, while others report that food insecurity is associated with a greater need for care, leading to more care utilisation. We use data from the Harambee study in western Kenya to assess the association between food insecurity and difficulty accessing care among people living with HIV (PLWH) with or without comorbid non-communicable diseases (NCDs).Methods The Harambee study is a cluster randomised trial that tested the effectiveness of delivering integrated HIV and NCD care for PLWH. In this cross-sectional analysis, we examined baseline data from Harambee participants to investigate the relationship between household food insecurity and difficulty accessing care, using multivariable logistic regression models, controlling for sociodemographic factors and care satisfaction. We tested for effect measure modification by gender and household wealth and stratified analyses by NCD status.Results Among 1039 participants, 11.1% reported difficulty accessing care, and 18.9% and 51.9% of participants had moderate and severe food insecurity, respectively. Among those with difficulty accessing care, 73.9% cited transportation issues as the major barrier. Difficulty accessing care was greater with higher levels of food insecurity: among participants with low, moderate and severe food insecurity, 5.9%, 9.7% and 14.4% reported difficulty accessing care, respectively. After adjusting for confounders, severe food insecurity was independently associated with difficulty accessing care (adjusted OR=2.5, 95% CI 1.4 to 4.4). There was no statistical evidence for effect measure modification by gender or wealth.Conclusions We found that greater food insecurity was associated with greater difficulty accessing care among PLWH with or without NCDs in rural western Kenya. These findings suggest that addressing social determinants of health may be necessary when implementing integrated HIV and NCD care programmes.https://gh.bmj.com/content/9/12/e016721.full |
| spellingShingle | Rajesh Vedanthan Dan N Tran Juddy Wachira Catherine Kafu Marta Wilson-Barthes Omar Galárraga Sonak D Pastakia Manuel Vazquez Sanchez Jamil Said Becky Genberg Mariam Ardehali Ben Mosong Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya BMJ Global Health |
| title | Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya |
| title_full | Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya |
| title_fullStr | Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya |
| title_full_unstemmed | Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya |
| title_short | Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya |
| title_sort | food insecurity is associated with greater difficulty accessing care among people living with hiv with or without comorbid non communicable diseases in western kenya |
| url | https://gh.bmj.com/content/9/12/e016721.full |
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