Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

Jason M Nagata; Joshua D Miller; Craig R Cohen; Edward A Frongillo; Elly Weke; Rachel Burger; Pauline Wekesa; Lila A Sheira; A Rain Mocello; Phelgona Otieno; Lisa M Butler; Elizabeth A Bukusi; Sheri D Weiser; Sera L Young

doi:10.1007/s10461-021-03410-w

Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya

AIDS Behav. 2022 Feb;26(2):549-555. doi: 10.1007/s10461-021-03410-w. Epub 2021 Aug 9.

Authors

Jason M Nagata^{1

2}, Joshua D Miller³, Craig R Cohen⁴, Edward A Frongillo⁵, Elly Weke⁶, Rachel Burger⁴, Pauline Wekesa⁶, Lila A Sheira⁷, A Rain Mocello⁴, Phelgona Otieno⁸, Lisa M Butler⁹, Elizabeth A Bukusi^{4

6}, Sheri D Weiser⁷, Sera L Young^{10

11}

Affiliations

¹ Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, CA, 94158, USA. jason.nagata@ucsf.edu.
² Institute for Global Health Sciences, University of California, San Francisco, CA, USA. jason.nagata@ucsf.edu.
³ Department of Nutrition, University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.
⁴ Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA.
⁵ Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA.
⁶ Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
⁷ Department of Medicine, University of California, San Francisco, CA, USA.
⁸ Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
⁹ Institute for Collaboration On Health, Intervention and Policy, University of Connecticut, Storrs, CT, USA.
¹⁰ Department of Anthropology, Northwestern University, Evanston, IL, USA.
¹¹ Institute for Policy Research, Northwestern University, Evanston, IL, USA.

Abstract
in English, Spanish

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

El acceso seguro al agua potable en cantidades suficientes (es decir, seguridad hídrica) es importante para la adherencia a la medicación y para limitar la exposición a patógenos; sin embargo, estudios anteriores solo han considerado el papel de la seguridad alimentaria como un determinante social de salud relacionado con el VIH. Por lo tanto, el objetivo de este análisis fue evaluar las relaciones entre la inseguridad hídrica en hogares y los resultados relacionados con el VIH en adultos que viven con VIH en el oeste de Kenia (N = 716). Realizamos un análisis transversal de los datos basales de la iniciativa Shamba Maisha (NCT02815579), un ensayo controlado aleatorio por conglomerados de una intervención multisectorial de créditos para insumos agrícolas. Los datos basales se recopilaron de junio de 2016 a diciembre de 2017. Evaluamos las asociaciones entre la inseguridad hídrica y resultados relacionados con el VIH, ajustando por factores de confusión clínicos y conductuales, incluyendo inseguridad alimentaria. Cada cinco unidades superiores de puntajes de inseguridad hídrica doméstica (rango: 0-51) fue asociado con 1.21 mayores probabilidades de tener una carga viral más alta ≥ 1000 copias / ml (CI 95%: 1,07-1,36) y con 1.26 mayores probabilidades de factores determinantes del SIDA (CI 95%: 1,11-1,42). La inseguridad de hídrica doméstica no se asoció con el recuento de células CD4 (B: −0,27; CI 95%: -13,59-13,05). Los programas de tratamiento y de apoyo al VIH deben considerar evaluar y abordar la inseguridad hídrica además de la inseguridad alimentaria para optimizar los resultados del VIH.

Keywords: AIDS; Food insecurity; Human immunodeficiency virus; Kenya; Water insecurity.

Publication types

Randomized Controlled Trial

MeSH terms

Acquired Immunodeficiency Syndrome*
Cross-Sectional Studies
Food Supply
HIV Infections* / drug therapy
HIV Infections* / epidemiology
Humans
Kenya / epidemiology
Water Insecurity

Abstract in English, Spanish

Publication types

MeSH terms

Grants and funding

Abstract
in English, Spanish