by A program for people with HIV that provides healthy food and nutrition counseling led to fewer hospital admissions, better treatment adherence and improvements in mental and physical health, according to study results published in the Journal of Infectious Diseases.
“Medically adapted meals and groceries, combined with nutrition education, reduced hospitalizations, improved mental health and medication adherence and reduced unprotected sex among people with HIV who are at high risk of food insecurity, ” concluded the authors of the study. “These results show promise [tailored food programs] to improve multiple areas of health for people living with HIV and reduce health care costs through lower health care utilization.”
That is well known nutritious diet key to good health, but many people have little knowledge of good nutrition and limited access to affordable healthy food. Inconsistent access to healthy food is recognized as a key determinant of poor health among people living with HIV, and support for a “food is medicine” approach is growing.
Food support for people with HIV in the United States is a “combined view” of government support, including the Supplemental Nutrition Assistance Program (“food stamps”) and the Ryan White HIV/AIDS program, non-profit agencies and community-based programs such. as church food pantries and soup kitchens, Kartika Palar, PhD, of the University of California San Francisco, and colleagues noted as background.
“Traditional nutritional safety net approaches focus on preventing hunger and reducing economic distress but sometimes have unintended consequences that undermine health, such as providing foods high in salt or sugar,” they wrote. In contrast, the healthier food approach has the potential to “address the dual goals of improving food security and health.”
Previous studies have linked food insecurity in wealthy countries to high rates of depression, anxiety and other mental health conditions, increased risk of HIV and other sexually transmitted infections (STIs), poorer adherence to antiretroviral treatment, higher viral loads, lower CD4 cell counts lower and increased mortality. But there have been no previous randomized trials of food programs tailored to people with HIV.
The Palar team conducted a study to evaluate results among the current clients of Conradh na Gaeilge Project Open Hand, a non-profit organization based in San Francisco that provides food assistance to people with chronic illnesses. The CHEFS-HIV trial (NCT03191253), conducted during 2016-2017, included almost 200 low-income people with HIV. The study compared 93 clients who were randomly assigned to participate in a special food program and 98 who received standard food services.
The majority of participants were middle-aged men (median age 55 years), and had been living with HIV for a median of 22 years. About a third were white, a quarter were Black and about 10% were Latino. At baseline, 39% had uncontrolled HIV, higher than the citywide percentage. Many had comorbidities, including diabetes, hypertension and cardiovascular disease; mental health and substance use diagnoses were common. The median income was approximately $1,000 per month, and more than 60% reported food insecurity. Participants had to be able to store and reheat perishable food, which left some homeless homeless out of the picture.
People in the intervention group received medically appropriate meals and groceries tailored to support their health (either 14 frozen prepared meals or seven meals and groceries each week) as well as an extra grocery bag to meet their needs rounding off nutrition. They also participated in three group nutrition education classes led by a registered dietitian and two individual nutrition counseling sessions. The people in the control group received the usual weekly allocation of meals and groceries (enough for one or two meals a day) and met briefly with a dietitian every six months. Food could be delivered if clients were unable to pick it up. Health, nutritional and behavioral outcomes were assessed at baseline and six months later.
At six months, nearly 90% of participants in both groups remained in the study. People in the intervention group reported less food insecurity and ate less fatty food, although there was no difference in reported fruit and vegetable consumption. People in the program were 89% less likely to be hospitalized, and the researchers estimated that the intervention could reduce hospital costs by $178,781. People receiving enhanced food services were also 90% less likely to report depression, unprotected sex and adherence to treatment. Viral suppression rates improved in both groups, with no significant difference between them. Despite these favorable results, there was no significant difference in health-related quality of life reported.
“The CHEFS-HIV intervention is six months, building on an intensive community-based program [medically tailored meals and groceries] with registered dietitian-led nutrition education, did not impact HIV viral suppression or health-related quality of life,” the study authors concluded. “However, it improved food security and [antiretroviral therapy] adherence and reduced severity of depressive symptoms, unprotected sexual contact and overnight hospitalizations, compared to controls.”
The researchers speculated that the decrease in unprotected sex may have occurred because addressing food insecurity reduced the need to engage in transactional sex or succumb to pressure to have unprotected sex to obtain food resources. “Thus, physician-tailored food programs may contribute to STI population reduction efforts by reducing unprotected sex among individuals whose sexual decision-making is influenced by food insecurity,” they wrote.
The differences between the groups may have been reduced because both groups received meals and groceries, the researchers suggested. It is likely that the effect would have been stronger if the intervention group had been compared to people who did not receive any food aid. In relation to viral suppression, the majority of participants in both groups had HIV control at baseline, and city facilities Go to Zero initiative to improve viral suppression rates throughout the city started at about the same time.
“Although suppressed viral load is critical to the health of people with HIV and to reducing HIV transmission, social factors related to food insecurity often contribute significantly to emergency department use, hospitalization, and death in San Francisco,” wrote the researchers. “These factors may explain the reduced hospitalizations with the intervention, despite the lack of effect on viral suppression.”
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