Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Wester
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ORIGINAL PAPER
Social Support Mitigates Negative Impact of Food Insecurity on Antiretroviral Adherence Among Postpartum Women in Western Kenya Mira Wang1 · Joshua D. Miller1 · Shalean M. Collins1 · Marianne V. Santoso1 · Pauline Wekesa2 · Hideaki Okochi3 · Maricianah Onono2 · Sheri Weiser3 · Monica Gandhi3 · Sera L. Young1,4
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0–27), social support (0–40), and HRQoL (8–40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: −64.3%, −15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period. Keywords Antiretroviral adherence · Hair ART drug concentrations · Food insecurity · Social support · Postpartum
Introduction Adherence to antiretroviral treatment (ART) is critical for suppressing viral loads and maintaining the health of people living with HIV [1]. Suboptimal adherence can lead to poor treatment efficacy and negative health outcomes, including increased levels of inflammation, virologic failure, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10461-020-02839-9) contains supplementary material, which is available to authorized users. * Sera L. Young [email protected] 1
Department Anthropology, Program in Global Health, Northwestern University, Evanston, IL 60208, USA
2
Family Aids Care and Education Services (FACES), Kenya Medical Research Institute, Kisumu, Kenya
3
Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
4
Institute for Policy Research, Northwestern University, Evanston, IL 60208, USA
co-infections, and death [1–3]. Patients may also experience an increased likelihood of viral drug resistance and treatment failure [4]. In low-resource settings, where diagnostic tests for drug resistance and late-stage ART regimens may be prohibitively expensive or difficult to procure, maintaining optimal ART adherence to first-line medications is critical for long-term health [4, 5]. Optimal adherence is particularly important during the perinatal period for mother
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