The syndemic effects of food insecurity, depression, and gender-based violence on HIV treatment outcomes among people with HIV in Zimbabwe

Abstract

The effects of food insecurity (FI) on mental health and HIV treatment outcomes among people with HIV (PWH) in Zimbabwe are not well understood, despite its high prevalence and links to poor health. We examined associations between FI and self-reported health quality, viral load, CD4 count, antiretroviral therapy (ART) adherence, depression diagnosis and symptoms, and gender-based violence (GBV) among PWH in Zimbabwe. Participants were 484 PWH receiving HIV care in Mashonaland East Province who were assessed for enrollment in a randomized controlled trial for depression. Associations were estimated using linear or logistic regression, controlling for gender and income type. We also tested an interaction between FI and depression on ART adherence. In the past 12 months, 51% reported having skipped a meal (moderate FI) and 29% reported having skipped an entire day of eating (severe FI). Moderate FI was associated with poorer overall perceived health quality (b = -8.48, 95%CI[-12.86 to -4.10], p <.001), increased likelihood of depression diagnosis (OR = 2.13, 95%CI[1.47–3.11], p <.001), greater depression severity (b = 0.89, 95%CI[0.27–1.51], p =.005), and being a woman who experienced GBV (OR = 2.35, 95%CI[1.43–3.93], p =.001). Severe FI was associated with poorer overall perceived health (b = -8.02, 95%CI[-12.89 to -3.16], p =.001), increased likelihood of depression diagnosis (OR = 2.91, 95%CI[1.92–4.43], p <.001), greater depression symptom severity (b = 1.36, 95%CI[0.68–2.04], p <.001), and poorer medication adherence (b = -3.90, 95%CI[-7.58 to -0.22], p =.038). There was an interaction between moderate FI and depression diagnosis on ART adherence (b = -8.88, 95%CI[-15.71 to -2.05], p =.011). Screening and targeted interventions are needed to address FI among PWH in Zimbabwe.