Food and water insecurity in households of children and adolescents living with HIV and receiving care in a rural Zambian hospital: A mixed-methods study.

Approximately 62,000 Zambian children are living with HIV. HIV care and treatment is generally more limited in rural areas, where a heavy reliance on rain-fed subsistence agriculture also places households at risk of food and water insecurity. We nested a mixed methods study with an explanatory sequential design in a clinical cohort of children and adolescents living with HIV (CHIV) in rural Zambia. We used validated questionnaires to assess household food and water insecurity and examined associations between indicators derived from those scales, household characteristics, and HIV treatment adherence and outcomes using log-binomial regression. We identified caregivers and older CHIV from food insecure households for in-depth interviews. Of 186 participants completing assessments, 72% lived in moderately or severely food insecure households and 2% in water insecure households. Food insecurity was more prevalent in households of lower socioeconomic status (80% vs. 59% for higher scores; p = 0.02) and where caregivers had completed primary (79%) vs. secondary school or higher (62%; p = 0.01). No other characteristics or outcomes were associated with food insecurity. Parents limited both the quality and quantity of foods they consumed to ensure food availability for their CHIV. Coping strategies included taking on piecework or gathering wild foods; livestock ownership was a potential buffer. Accessing sufficient clean water was less of a concern. During periods of drought or service interruption, participants travelled further for drinking water and accessed water for other purposes from alternative sources or reduced water use. Community contributions afforded some protection against service interruptions. Overall, while food insecurity was prevalent, strategies used by parents may have protected children from a measurable impact on HIV care or treatment outcomes. Reinforcing social protection programs by integrating livestock ownership and strengthening water infrastructure may further protect CHIV in the case of more extreme food or water system shocks.

Massive open online course on breastfeeding during the COVID-19 pandemic in Mexico.

BACKGROUND: COVID-19 virus was reported to be transmitted through breastfeeding (BF), creating the need for rapidly available, standardized information and training for health personnel and the community about BF as an urgent action to reduce misinformation and unethical promotion of breast milk substitutes (BMS). In Mexico, a massive open online course (MOOC) was designed and implemented to protect, promote and support BF in emergency contexts. METHODS: MOOC registration consisted of collection of quantitative data regarding participant characteristics, MOOC coverage, scores achieved and completion rates. A multiple linear regression analysis was performed to relate the absolute and relative skills earned in the MOOC to participant characteristics. In addition, factors associated with completion rate and dissemination of information from the MOOC were analyzed using multiple logistic regression and presented as odds ratios. RESULTS: During a period of 19 months, 52,426 participants across the country, including health personnel and general population, entered the Cursos en Linea del Instituto Mexicano del Seguro Social (CLIMSS) platform, of which 50.5% completed the MOOC. The level of participation was maintained from January 2021 to early 2022 when the perception of the risk of getting sick from COVID-19 and quarantining decreased. In adjusted analysis, completion rate was associated with being older or belonging to a health institution; furthermore, residing in the north of the country doubled the odds of completing the MOOC (odds ratio 2.24; 95% confidence interval 1.95-2.56). CONCLUSIONS: A MOOC can be a useful training strategy to disseminate information, especially in emergencies where physical distancing is important and reaching the largest possible population is required.

Depressive symptoms, HIV-related stigma and ART adherence among caregivers of children in vulnerable households in rural southern Malawi.

BACKGROUND: Few studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect ART adherence among caregivers who report testing positive for HIV and currently on ART. METHODS: We interviewed 818 adult caregivers of children aged 0-17 years living in vulnerable households in 24 health facility catchment areas in five districts in rural southern Malawi in 2016-2017. Vulnerable households had either economic and food insecurity, or chronic illness. Questions on five depressive symptoms were used. ART adherence was self-report of not forgetting to take ART medication in the last week. Perceived and anticipated measures of stigma were used. Multivariable linear and logistic regressions documented relationships between depressive symptoms, self-reported HIV status, HIV-related stigma, and ART adherence. RESULTS: Most caregivers were women (86.2%); about one third had no spouse or live-in partner. Fifty-seven percent of caregivers reported having three or more depressive symptoms. Forty-one percent of caregivers reported testing positive for HIV. Self-reported HIV positive status was associated with depressive symptoms (adjusted coeff = 0.355, p-value <0.001), which were in turn associated with poorer ART adherence among caregivers (aOR 0.639, p-value = 0.023). HIV-related stigma was also associated with depressive symptoms for caregivers who reported having HIV (coeff = 0.302, p-value = 0.028) and those who reported testing negative for HIV (coeff = 0.187, p-value <0.001). Having social support was associated with lower depressive symptoms (coeff = -0.115, p = 0.007). HIV-related stigma, having social support, and other socio-demographic characteristics were not found to be associated with ART adherence. CONCLUSIONS: Addressing mental health among caregivers in vulnerable households may be an important step toward achieving viral suppression among vulnerable populations living with HIV in Malawi. Integrating depression screening into HIV care and treatment protocols could be a promising intervention to improve longer-term outcomes.