Critical level of food insecurity and nonadherence to antiretroviral therapy among adults living with HIV

BACKGROUND: Adherence to antiretroviral therapy (ART) is crucial for the clinical management of people living with HIV (PLHIV), but food insecurity can compromise it. The threshold at which food insecurity significantly affects adherence remains poorly studied. METHODS: A cross-sectional study was conducted in health care facilities in Kinshasa among 506 PLHIV receiving outpatient ART. Socio-demographic, clinical, behavioural, and nutritional data were collected through structured interviews and medical record reviews. Chi-square tests and logistic regression analyses were performed using Stata version 17.0 software, with a statistical significance threshold set at P < 0.05. RESULTS: Proportion of ART nonadherence was 51.4%. Overall, 74.9% of participants were food insecure, including 56.5% with severe food insecurity. In multivariate analysis, severe food insecurity was strongly associated with nonadherence (adjusted odds ratio [aOR] = 5.98). Other predictors included alcohol use (aOR = 1.93), absence of viral load monitoring (aOR = 1.63), travel outside Kinshasa (aOR = 3.52), and being widowed or divorced (aOR = 2.18). ART refill intervals of 3–6 months were protective (aOR = 0.42). CONCLUSION: Severe food insecurity significantly undermines ART adherence. Integrating targeted nutritional support into HIV programmes, alongside biomedical care, may help improve treatment adherence and support progress towards achieving the UNAIDS 95-95-95 goals.