HIV This Week

Cantrell RA, Sinkala M, Megazinni K, Lawso-Marriott S, Washington S, Chi BH, Tambatamba-Chapula B, Levy J, Stringer EM, Mulenga L, Stringer JS. A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):190-5.

The provision of food supplementation to food-insecure patients initiating antiretroviral therapy (ART) may improve adherence to medications. In a home-based adherence support program at 8 government clinics Cantrell et al assessed patients for food insecurity. Four clinics provided food supplementation, and 4 acted as controls. The analysis compared adherence (assessed by medication possession ratio), CD4, and weight gain outcomes among food-insecure patients enrolled at the food clinics with those enrolled at the control clinics. Between May 1, 2004, and March 31, 2005, 636 food- insecure adults were enrolled. Food supplementation was associated with better adherence to therapy. Two hundred fifty-eight of 366 (70%) patients in the food group achieved a medication possession ratio of 95% or greater versus 79 of 166 (48%) among controls (relative risk = 1.5; 95% confidence interval: 1.2 to 1.8). This finding was unchanged after adjustment for sex, age, baseline CD4 count, baseline World Health Organization stage, and baseline haemoglobin. The authors did not observe a significant effect of food supplementation on weight gain or CD4 cell response. This analysis suggests that providing food to food-insecure patients initiating ART is feasible and may improve adherence to medication. A large randomized study of the clinical benefits of food supplementation to patients on antiretroviral treatment is urgently needed to inform international policy.

Editors’ note: Poor nutrition can undermine adherence by potentiating drug toxicity and making people too tired to travel to the pharmacy to obtain medications. With one third of Zambians and almost half of people on antiretroviral treatment in Zambia ‘food insecure’, meaning lacking consistent access to enough food of sufficient variety to meet dietary needs, the findings of this randomised study of food supplementation for households in which a person on antiretroviral treatment resides are important. External funding from donors that is earmarked for HIV treatment in similar settings should include a food supplementation component in the interests of improved patient adherence to medication.