Assessing the Impact of Food Insecurity on HIV Medication Adherence in the Context of an Integrated Care Facility for People Living with HIV in Vancouver, Canada

Objective Food insecurity, or self-reports of inadequate food access due to limited financial resources, remains prevalent among people living with HIV (PLHIV). We examined the impact of food insecurity on combination antiretroviral therapy (cART) adherence within an integrated care facility that provides services to PLHIV, including two meals per day. Design Adjusted odds ratios (aOR) were estimated by generalized estimating equations, quantifying the relationship between food insecurity (exposure) and cART adherence (outcome) with multivariable logistic regression. Setting We drew on survey data collected between February 2014-March 2016 from the Dr. Peter Centre Study based in Vancouver, Canada. Participants This study included 116 PLHIV at baseline, with 99 participants completing a 12-month follow-up interview. The median age was 46 years (IQR: 39-52) at baseline, and 82% (n=95) were biologically male at birth. Results At baseline, 74% (n=86) of participants were food insecure (≥ 2 affirmative responses on Health Canada’s Household Food Security Survey Module) and 67% (n=78) were adherent to cART ≥ 95% of the time. In the adjusted regression analysis, food insecurity was associated with suboptimal cART adherence (aOR=0.47, 95% confidence interval = 0.24-0.93). Conclusions While food provision may reduce some health-related harms, there remains a relationship between this prevalent experience and suboptimal cART adherence in this integrated care facility. Future studies that elucidate strategies to mitigate food insecurity and its affects on cART adherence among PLHIV in this setting and in other similar environments are necessary