Food insecurity is associated with greater difficulty accessing care among people living with HIV with or without comorbid non-communicable diseases in western Kenya.

Autor:	Ardehali M; Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA m.a@northwestern.edu., Kafu C; Academic Model Providing Access to Healthcare, Eldoret, Kenya., Vazquez Sanchez M; Population Health, New York University Grossman School of Medicine, New York, New York, USA., Wilson-Barthes M; Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA., Mosong B; Academic Model Providing Access to Healthcare, Eldoret, Kenya., Pastakia SD; Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana, USA., Said J; Academic Model Providing Access to Healthcare, Eldoret, Kenya.; Department of Health Anatomy, Moi University College of Health Sciences, Eldoret, Central, Kenya., Tran DN; Academic Model Providing Access to Healthcare, Eldoret, Kenya.; Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA., Wachira J; Department of Behavioral Science, Moi University School of Medicine, Eldoret, Central, Kenya., Genberg B; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA., Galarraga O; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA., Vedanthan R; Population Health, New York University Grossman School of Medicine, New York, New York, USA.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2024 Dec 02; Vol. 9 (12). Date of Electronic Publication: 2024 Dec 02.
DOI:	10.1136/bmjgh-2024-016721
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu