Clinic-Based Food Assistance is Associated with Increased Medication Adherence among HIV-Infected Adults on Long-Term Antiretroviral Therapy in Zambia
- *Corresponding Author:
- John R. Koethe MD, MS
Division of Infectious Diseases
Vanderbilt University Medical Center
A2200-MCN, 1161 21st Avenue South Nashville, USA
Tel: 37232-2582, Office : 615-322-2035
E-mail: [email protected]
Received Date: August 24, 2012; Accepted Date: September 21, 2012; Published Date: September 24, 2012
Citation: Tirivayi N, Koethe JR, Groot W (2012) Clinic-Based Food Assistance is Associated with Increased Medication Adherence among HIV-Infected Adults on Long-Term Antiretroviral Therapy in Zambia. J AIDS Clinic Res 3:171. doi:10.4172/2155-6113.1000171
Copyright: © 2012 Tirivayi N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: There has been limited research to date on the effects of food assistance provided to HIV-infected adults in resource-constrained settings with a high prevalence of malnutrition and chronic food insecurity. We compare Antiretroviral Therapy (ART) adherence, weight gain, and CD4+ lymphocyte change among HIV-infected adult enrolled in a clinic-based food assistance program in Lusaka, Zambia versus a control group of non-recipients. Methods: We conducted a cohort study incorporating interviewer-administered surveys and retrospective clinical data to compare ART patients receiving food assistance with a control group of non-recipients. Medication adherence was assessed using pharmacy dispensation records. We use propensity score matching to assess the effect of food assistance on outcome measures. Results: After 6 months, food assistance recipients (n=145) had higher ART adherence compared to nonrecipients (n=147, 98.3% versus 88.8%, respectively; p<0.01), but no significant effects were observed for weight or CD4+ lymphocyte count change. The improvement in adherence rates was greater for participants on ART for less than 230 days, and those with BMI<18.5 kg/m2, a higher HIV disease stage, or a CD4+ lymphocyte count ≤ 350 cells/μl. Conclusions: Promoting optimal medication adherence among persons on ART is relevant to public health and the success of HIV control efforts. The provision of food assistance to HIV-infected adults on ART may have an incentivizing effect which can improve medication adherence, particularly among patients recently initiated on treatment and those with poor nutrition or advanced disease. The effects on body weight and immune reconstitution appear minimal.