Health status, food insecurity, and time allocation patterns of patients with AIDS receiving antiretroviral treatment in South Africa

ABSTRACT

For patients with AIDS receiving antiretroviral treatment (ART) in South Africa via public clinics, improvements in nutritional status and economic productivity are likely to depend on adherence to drug regimen and quality of diet reflected in protein and micronutrient intakes. This study randomized 643 patients receiving ART from public clinics in the Free State Province into a Control group, a treatment group receiving adherence support, and a treatment group receiving adherence support and a nutritious food supplement. The data on food insecurity levels and time spent on various activities were analyzed for assessing the impact of the intervention programs. The main results were, first, changes between survey rounds 1 and 3 were significant at the 5% level for outcomes such as food insecurity levels and CD4 cell counts. Moreover, there was a significant reduction in food insecurity levels of patients with BMI less than 25 who received the nutritious food supplement. Second, the estimated parameters from models for patients’ food insecurity levels showed that household incomes were significantly associated with lower food insecurity levels. Third, patients’ BMI was a significant predictor of time spent on sedentary, moderate and overall activity levels, and it was important to separately evaluate the effects of BMI for under-weight and over-weight patients. Overall, the results indicated the need for reducing food insecurity levels, and for designing different interventions for under-weight and over-weight patients with AIDS for enhancing their labor productivity.

KEYWORDS:

• Antiretroviral treatment
• anthropometric measures
• CD4 cells
• dynamic random effects models
• food insecurity
• labor productivity
• obesity
• time allocation

Acknowledgements

While retaining the responsibility for the views, the authors thank the participants, field staff, and Larry Howard and Solomiya Shpak for their valuable help. This revision has benefitted from the comments of the two reviewers.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This randomized controlled trial [DOH-27-0907-2025] and [NCT00821366] was supported by the Research Committee of World Bank and the World Bank-Netherlands and DFID Evaluation partnership. Partial support for the analyses was provided by the University of Maryland.