Food insecurity predicts loss to follow-up among people living with HIV in Senegal, West Africa

ABSTRACT

The goals of this study were to assess retention on antiretroviral therapy (ART) and to identify predictors of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Senegal. HIV-positive individuals presenting for initiation of ART in Dakar and Ziguinchor were enrolled and followed for 12 months. Data were collected using interviews, clinical evaluations, laboratory analyses, chart review, and active patient tracing. Of the 207 individuals enrolled, 70% were female, 32% had no formal education, and 28% were severely food insecure. At the end of the follow-up period, 58% were retained on ART, 15% were deceased, 4% had transferred care, 5% had migrated, and 16% were lost to follow-up. Enrollment in Ziguinchor (OR 2.71 [1.01-7.22]) and severe food insecurity (OR 2.55 [1.09-5.96]) were predictive of LTFU. Sex, age, CD4 count, BMI <18.5, country of birth, marital status, number of children, household size, education, consultation with traditional healers, transportation time, and transportation cost were not associated with LTFU. The strongest predictor of severe food insecurity was lack of formal education (OR 2.75 [1.30-5.80]). Addressing the upstream drivers of food insecurity and implementing strategies to enhance food security for PLHIV may be effective approaches to reduce LTFU and strengthen the HIV care cascade in the region.

KEYWORDS:

• HIV
• retention in care
• loss to follow-up
• antiretroviral therapy
• care cascade
• food insecurity
• social determinants
• West Africa

Acknowledgements

The authors would like to thank the study participants and the staff of the Services des Maladies Infectieuses et Tropicales and the Centre Régional de Recherche et de Formation à la Prise en Charge Clinique, Centre Hospitalier Universitaire de Fann and the Centre de Santé de Ziguinchor.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by the National Institutes of Health (National Institute of Allergy and Infectious Diseases, K23 AI120761 to N.A.B). The funding body had no role in the design of the study, collection, analysis, or interpretation of data, or in writing the manuscript.