Assessing the impact of food insecurity on HIV medication adherence in the context of an integrated care programme for people living with HIV in Vancouver, Canada.

OBJECTIVE: Food insecurity, or self-reports of inadequate food access due to limited financial resources, remains prevalent among people living with HIV (PLHIV). We examined the impact of food insecurity on combination antiretroviral therapy (cART) adherence within an integrated care programme that provides services to PLHIV, including two meals per day. DESIGN: Adjusted OR (aOR) were estimated by generalized estimating equations, quantifying the relationship between food insecurity (exposure) and cART adherence (outcome) with multivariable logistic regression. SETTING: We drew on survey data collected between February 2014 and March 2016 from the Dr. Peter Centre Study based in Vancouver, Canada. PARTICIPANTS: The study included 116 PLHIV at baseline, with ninety-nine participants completing a 12-month follow-up interview. The median (quartile 1-quartile 3) age was 46 (39-52) years at baseline and 87 % (n 101) were biologically male at birth. RESULTS: At baseline, 74 % (n 86) of participants were food insecure (≥2 affirmative responses on Health Canada's Household Food Security Survey Module) and 67 % (n 78) were adherent to cART ≥95 % of the time. In the adjusted regression analysis, food insecurity was associated with suboptimal cART adherence (aOR = 0·47, 95 % CI 0·24, 0·93). CONCLUSIONS: While food provision may reduce some health-related harms, there remains a relationship between this prevalent experience and suboptimal cART adherence in this integrated care programme. Future studies that elucidate strategies to mitigate food insecurity and its effects on cART adherence among PLHIV in this setting and in other similar environments are necessary.

Role of a food box program in fruit and vegetable consumption and food security.

PURPOSE: We examined whether participation in a food box program has a positive effect on fruit and vegetable consumption and food security. METHODS: Participants and nonparticipants in a food box program were surveyed to determine differences between the two groups and change over time. RESULTS: Fruit and vegetable intake declined in those who left the program after several months, and intake of fruit, carrots, and vegetables was lower among those who had left than among those who remained in the program. Food insecurity was associated with lower intakes of fruit and vegetables. CONCLUSIONS: Participation in a food box program can provide some benefit in terms of increased fruit and vegetable consumption for those who use the program regularly. Increasing the frequency of the box and encouraging continued use may improve these effects.

"I do my best to eat while I'm using": Mapping the foodscapes of people living with HIV/AIDS who use drugs.

Food insecurity can have negative health impacts on people who use drugs and are living with HIV/AIDS (PLHIV). These include both physical effects, including poorer health outcomes and morbidity, and also behaviors that can increase the risk of physical or psychological harm. This study used a semi-structured survey of 60 PLHIV who use drugs and service access mapping (SAM) interviews of a 20-person subset. The mapping helped to illustrate the daily routines used to access food and how food provision may contribute to both spaces of risk and care for a cohort of PLHIV who use drugs in Vancouver, BC. Study participants mapped the daily routes used to access food and discussed whether they felt that these routines increased their risk of physical harm. Additionally, study participants noted which food provision spaces provide social and health supports, which may protect against the nutritional and other harms of drug use. This study revealed that having access to space providing stable and reliable sources of food may protect individuals from experiencing certain risks associated with accessing food, including violence in food line-ups, having to enter areas of the city they considered unsafe or 'triggering' and engaging in risky behaviors in order to access food. These "spaces of care" not only provide nutrition but also social support and connections.

Development of a support tool for complex decision-making in the provision of rural maternity care.

CONTEXT: Decisions in the organization of safe and effective rural maternity care are complex, difficult, value laden and fraught with uncertainty, and must often be based on imperfect information. Decision analysis offers tools for addressing these complexities in order to help decision-makers determine the best use of resources and to appreciate the downstream effects of their decisions. OBJECTIVE: To develop a maternity care decision-making tool for the British Columbia Northern Health Authority (NH) for use in low birth volume settings. DESIGN: Based on interviews with community members, providers, recipients and decision-makers, and employing a formal decision analysis approach, we sought to clarify the influences affecting rural maternity care and develop a process to generate a set of value-focused objectives for use in designing and evaluating rural maternity care alternatives. SETTING: Four low-volume communities with variable resources (with and without on-site births, with or without caesarean section capability) were chosen. PARTICIPANTS: Physicians (20), nurses (18), midwives and maternity support service providers (4), local business leaders, economic development officials and elected officials (12), First Nations (women [pregnant and non-pregnant], chiefs and band members) (40), social workers (3), pregnant women (2) and NH decision-makers/administrators (17). RESULTS: We developed a Decision Support Manual to assist with assessing community needs and values, context for decision-making, capacity of the health authority or healthcare providers, identification of key objectives for decision-making, developing alternatives for care, and a process for making trade-offs and balancing multiple objectives. The manual was deemed an effective tool for the purpose by the client, NH. CONCLUSIONS: Beyond assisting the decision-making process itself, the methodology provides a transparent communication tool to assist in making difficult decisions. While the manual was specifically intended to deal with rural maternity issues, the NH decision-makers feel the method can be easily adapted to assist decision-making in other contexts in medicine where there are conflicting objectives, values and opinions. Decisions on the location of new facilities or infrastructure, or enhancing or altering services such as surgical or palliative care, would be examples of complex decisions that might benefit from this methodology.