Exploring antiretroviral therapy adherence, competing needs, and viral suppression among people living with HIV and food insecurity in the Dominican Republic

ABSTRACT

Understanding factors related to suboptimal adherence to antiretroviral therapy (ART) and detectable viral load (VL), especially among vulnerable populations, is needed to improve HIV outcomes. The Caribbean is highly impacted by HIV and socioeconomic inequalities, but few studies have been conducted there to explore food insecurity among people with HIV and factors associated with viral suppression in this vulnerable population. Using baseline data from a pilot intervention trial among people living with HIV and food insecurity in the Dominican Republic, we examined psychosocial and behavioral factors associated with viral suppression, ART adherence, and competing needs. Among participants (n = 115), 61% had a detectable VL; the strongest factor associated with detectable VL was having missed taking ART in the last six months due to not having food (OR = 2.68, p = 0.02). Greater odds of reporting missed ART doses due to not having food were associated with severe food insecurity (OR = 4.60, p = 0.006), clinical depression (OR = 2.76, p = 0.018), Haitian background (OR = 6.62 p = 0.017), and internalized HIV stigma (OR = 1.09, p = 0.041), while lower odds were associated with social support (OR = 0.89, p = 0.03) and having health insurance (OR = 0.27, p = 0.017). Ensuring that people with HIV and food insecurity have food to take with their ART is essential for viral suppression.

KEYWORDS:

• HIV
• food insecurity
• viral suppression
• competing needs

Acknowledgements

The authors thank the study participants and clinic staff, especially the directors of the study clinics, Dr. Mirquella G. Rijo Ureña and Lcda. Chaira Rodríguez. They also acknowledge the important and generous in-kind support from Dr. Susana Santos Toribio of the Nutrition Department of the Dominican Ministry of Health. Finally, they recognize the on-going assistance to ensure the study’s success from Dr. Víctor Terrero, formerly Executive Director of CONAVIHSIDA, and Dr. Ángel Díaz, Director of Research at the Facultad de Ciencias de la Salud (School of Health Sciences) at the Universidad Autónoma de Santo Domingo.

Disclosure statement

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

Additional information

Funding

Research reported in this publication was supported by the National Institute of Mental Health (NIMH) of the National Institutes of Health under Award Number R34MH110325. Dr. Palar and Ms. Sheira’s contributions were supported by a grant from the National Institutes of Health (National Institute of Allergy and Infectious Diseases, NIAID) to the University of California, San Francisco (UCSF)-Gladstone Institute of Virology & Immunology Center for AIDS Research, Award Number P30AI027763; additional funding for Dr. Palar was provided by Award Number K01DK107335 from the National Institutes of Health (National Institute of Diabetes and Digestive and Kidney Diseases, NIDDK). The article contents are solely the responsibility of the authors and do not represent the official views of the National Institutes of Health (NIMH, NIAID, NIDDK) or UCSF.