The protocol for the Food Insecurity (FI) sub-study was developed by Dr. Joe Cox, a co-investigator of the CCC. From November 2012-October 2015, the sub-study was implemented into the CCC’s 17 sites and biannual data collection occurred. All CCC participants were invited to enroll in the FI sub-study. The primary objective was to understand the relationship between food security, behavioral and clinical factors related to HIV-HCV co-infection, health-related quality of life, and health and treatment outcomes among co-infected patients participating in HIV care in Canada.
Food security comprises 3 categories: 1) marginal food insecurity, 2) moderate food insecurity, and 3) severe food insecurity. Marginal and moderate food insecurity are indicative of worrying about running out of food or compromises in the quality and/or quantity of food consumed, whereas severe food insecurity indicates disrupted eating patterns and reduced food intake. Of 725 participants from 17 of the CCC sites, 468 (65% of respondents) did not have adequate access to food due to a lack of money. Not only were they 8 times more likely to be unable to get enough food compared with the general Canadian adult population, but over half of those living with HIV and hepatitis C were also foregoing meals and sometimes going day(s) without food (severe food insecurity).
Food insecurity was also associated with poor HIV virologic control, which means the inability to obtain nutritional and safe foods put the participants at risk of having a detectable HIV viral load. FI did not, however, have a significant impact on CD4 cell recovery, meaning limited access to food did not seem to have a major effect on immune function. Depressive symptoms seemed to explain some, but not all, of the effect of FI on HIV viral load, suggesting FI itself can have a negative impact on people’s ability to maintain HIV control. Possible reasons could be lack of regular food may mean some medications are not well absorbed, or that people experiencing FI may be forced to choose between buying food or paying for their medications. The article on the mediating effect of depressive symptoms on health outcomes related to FI can be found here:
https://pubmed.ncbi.nlm.nih.gov/31950306/
An info card with the result of this study was created as a knowledge transfer tool and was distributed to the CCC participants (see image below). It encouraged participants to talk with their health care providers if they are experiencing food insecurity, as there may be services available to help them access food.
The study results have been published in several scientific journals including AIDS and Behavior, Drug and Alcohol Dependence, and HIV Medicine. They were also published on the CATIE website – Canada’s source for HIV and hepatitis C information.
Two Ph.D. trainees in Epidemiology at McGill University, Taylor McLinden and Wusiman Aibibula were instrumental to the study’s success in advancing analyses and communicating related results.