High levels of food insecurity were observed among HIV, TB, and HIV/TB co‐infected outpatients in northern Uganda
Authors: Blakstad Mia Monique , Mehta Saurabh , Kuule Julius , Natamba Barnabas K 
Published: November 2023

Introduction

Food insecurity among individuals living with HIV is well‐recognized globally. Since comorbidity with TB is common, particularly in sub‐Saharan Africa, we examined the variation in the severity of food insecurity among people with either infection or both concurrently.

Methods

120 HIV+ only, 60 TB only and 60 HIV/TB co‐infected patients were systematically recruited from TB and HIV outpatient clinics at Gulu Regional Referral Hospital in northern Uganda. A survey consisting of participants socio‐demographic, household and food security variables was administered to study participants by trained interviewers. Food insecurity was assessed using the Individually‐focused FI Access Scale (IFIAS). Bivariate and multivariate regression models were used to compare continuous and categorical measures of FI among TB and HIV/TB co‐infected patients to that of patients infected with HIV only.

Results

Compared to TB or HIV/TB co‐infected patients, HIV infected patients were predominantly female. The Mean (SD) age of participants was 35.6 (11.3) and the age of TB or HIV/TB co‐infected patients did not differ significantly from that of HIV infected patients. Food insecurity (IFIAS) scores were 11.0 (5.9) and IFIAS scores of TB or HIV/TB co‐infected patients did not significantly differ from those of HIV infected patients in unadjusted or adjusted models. Overall, 55.4% and 89.6% of all participants reported experiencing severe and moderate‐to‐severe FI, respectively, and, like IFIAS scores, TB or HIV/TB co‐infected patients’ experience of severe or moderate‐to‐severe FI did not differ significantly from that of patients infected with HIV only.

Conclusion

We observed high levels of food insecurity among HIV, TB, and HIV/TB outpatients and the experience of food insecurity in patients with TB or HIV/TB did not differ from that of patients with HIV infection.

Support or Funding Information

Pears Foundation IMPH Alumni Seed‐Grant Program

Hebrew University of Jerusalem‐Hadassah Braun School of Public Health.

Characteristics of study participants overall and by HIV, TB, and HIV/TB co‐infection status.

Variable
All (n=240)
HIV (n=120)
TB (n=60)
HIV/TB (n=60)

Age
35.6 (11.3)
36.1 (9.9)
35.8 (15.5)
34.0 (8.7)

Female gender
139 (58.2%)
94 (78.3%)
20 (33.3%)***
25 (42.4%)***

Years of education
5.8 ± 4.6
4.8 ± 4.5
6.8 ± 4.3***
7.0 ± 4.6***

Widowed
39 (16.3%)
24 (20.0%)
8 (13.3%)***
7 (11.7%)****

Family size
5.2 ± 2.1
5.1 ± 2.1
5.8 ± 2.2***
4.8 ± 2.0

Household asset score
8.7 ± 3.0
8.3 ± 2.5
9.3 ± 3.3***
9.0 ± 3.4*

Ever been displaced
191 (79.9%)
93 (77.5%)
51 (85.0%)
47 (79.6%)

FI (IFIAS) score
11.0 ± 5.9
11.7 ± 5.6
10.5 ± 6.2*
10.0 ± 6.0*

Moderate‐to‐severe FI
215 (89.6%)
111 (92.5%)
52 (86.7%)
52 (86.7%)

Severe FI
133 (55.4%)
75 (62.5%)
26 (43.3%)***
32 (53.3%)

Estimates are mean ± SD or n (%n).

p<0.2;

p<0.1;

p<0.05 compared to HIV‐only patients.

Differences in food insecurity (IFIAS) scores among HIV, TB and HIV/TB co‐infected patients in northern Uganda

Variable
Unadjusted
Adjusted*

Effect
STD
P value
Effect
STD
P value

Disease status

HIV+
Reference
Reference

TB only
−1.20
0.93
0.1979
−0.61
0.84
0.4700

HIV/TB
−1.67
0.94
0.0760
−0.92
0.84
0.2754

Adjusted for these variables: age, household assets score, family size, and marital status

Differences in moderate‐to‐severe FI status among HIV, TB, and HIV/TB co‐infected patients in northern Uganda

Variable
Unadjusted
Adjusted*

OR
95%CI lower
95%CI upper
p value
OR
95%CI lower
95%CI upper
p value

Disease status

HIV+
Reference
Reference

TB
0.53
1.19
1.44
0.2129
0.58
0.20
1.68
0.3160

HIV/TB
0.53
0.19
1.44
0.2129
0.66
0.23
1.88
0.4331

Adjusted for these variable: household assets score and family size

Differences in severe FI status among HIV, TB, and HIV/TB co‐infected patients in northern Uganda

Variable
Unadjusted
Adjusted*

OR
95%CI lower
95%CI upper
p value
OR
95%CI lower
95%CI upper
p value

Disease status

HIV+
Reference
Reference

TB
0.46
0.24
0.86
0.0154
0.50
0.25
1.02
0.0567

HIV/TB
0.69
0.37
1.28
0.2387
0.79
0.40
1.59
0.5147

Adjusted for these variable: household assets score and whether participants had ever been internally displaced