Food insecurity among HIVpositive patients in Calgary, AB: Moving a population health concept into the clinical domain

Transcription

1 Food insecurity among HIVpositive patients in Calgary, AB: Moving a population health concept into the clinical domain Cherie Nicholson Dept. of Community Health Sciences, University of Calgary

2 Food Insecurity Food insecurity: a lack of access to affordable food Primary indicator is inadequate income A public health concern associated with poor health outcomes 6.9% adults in Canada experienced food insecurity in 2007 (CCHS 4.1)

3 Food Insecurity and HIV Nutrition Special diets Compromised nutritional status Drug therapy Clinical markers Cd4+ cell count HIV viral load

4 e.g, Anema et al., 2009; Normén et al., 2005, Weiser et al., 2009 What is the importance of food insecurity in the clinical domain?

5 Study Objectives Determine the 12-month prevalence of household food insecurity of the adult patient population in an HIV clinical population Examine the association between clinical and socio-demographic variables and household food insecurity in the adult HIV patient population

6 Southern Alberta Clinic (SAC) Calgary, AB 1200 patients Medications Food security not routinely assessed Provincial diet supplement for income support recipients

7 Methods Sampling adult patients at the SAC (n=1200) sample size n=260 consecutive sampling (February to April 2010)

8 Study Sample and SAC Comparison: Sex Study Sample SAC

9 Study Sample and SAC Comparison: Age Study Sample SAC

10 Study Sample and SAC Comparison: Ethnicity Study Sample SAC

11 Data Collection Household Food Security Survey Module (adult) Canadian Community Health Survey (10 questions) Food Secure: no or one indication of difficulty with income related food access (0-1 affirmative) Food Insecure, Moderate: indication of compromise in quality/quantity of food consumed (2-5 affirmative) Food Insecure, Severe: indication of reduced food intake and disrupted eating patterns (>6 affirmative) Electronic chart review Demographics Clinical variables (e.g. Cd4+ cell count)

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13 Demographics 261 patients interviewed

14 Clinical Variables

15 12-month prevalence of Household Food Insecurity at the SAC Food Security SAC Alberta (CCHS (adult), 2007) Canada (CCHS (adult), 2007) Total Food Insecurity Moderate Food Insecurity Severe Food Insecurity 22.2% 5.6% 6.9% 11.1% 4.4% 5.2% 11.1% 1.2 % 1.7%

16 Food Insecurity and CD4+ cell count Food Insecurity and CD4+ cell count Mean Absolute CD4+ cell count (cells/mm3) *p<0.05 Food Secure Mod Food Insecure Sev Food Insecure

17 Food Insecurity and HIV Viral Load Food Insecurity and HIV Viral load Log 10 mean HIV Viral Load (cells/mm) Food Secure Mod Food Insecure Sev Food Insecure *p<0.05

18 Exploratory Analyses Variable Sex Age Time since diagnosis Food Insecure Total Moderate Food Insecurity Severe Food Insecurity Hepatitis C * * HAART Illicit drug use * Immigration Homelessness * * * Ethnicity CD4+ cell count Viral load Baseline comparison is Food Secure; * p-value < 0.05

19 Preliminary Conclusions The prevalence of household food insecurity at the SAC is significantly higher than the general population Those experiencing Severe Food Insecurity have significantly poorer clinical markers than those who are food secure Drug use, Hepatitis C, and homelessness appear to be associated with food insecurity

20 Future Action Further analysis of correlates and demographics Dissemination of results to the SAC Determine if clinic will screen for food insecurity Appropriate tool and actions Dissemination of results to appropriate government agencies for policy considerations

21 Acknowledgements Supervisor: Dr. Lynn McIntyre CIHR Population Health Intervention Research Centre Canadian Public Health Association Staff at the SAC Tyler Williamson & Ken Fyie Thank-you!

22 References Anema, A., Druyts, E., Weiser, S., Fernandes, K., Brandson, E., Rourke, S., et al. (2009). Prevalence and correlates of food insecurity among HIV-infected individuals receiving highly active antiretroviral therapy in British Columbia. Vancouver: 18th Annual Canadian Conference on HIV/AIDS Research. Health Canada. (2010). Canadian Community Health Survey, Cycle 4.1 (2007), Income Related Food Insecurity in Canada. Health Canada. (2007). Canadian Community Health Survey, Cycle 2.2 (2004), Income Related Food Insecurity in Canada. Retrieved May 15, 2009, from Normén, L., Chan, K., Braitstein, P., Anema, A., Bondy, G., Montaner, J., et al. (2005). Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia. Journal of Nutrition, 135, pp Tarasuk, V. (2005). Household food insecurity in Canada. Topics in Clinical Nutrition, (4), pp Vozoris, N., & Tarasuk, V. (2003). Household food insufficiency is associated with poorer health. Journal of Nutrition, 133, pp Weiser, S., Bangsberg, D., Kegeles, S., Ragland, K., Kushel, M., & Frongillo, E. (2009). Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco. AIDS and Behavior (July).