Food insecurity is associated with increased food environment interactions and lower dietary adequacy among peri-urban Tanzanian households

Africa is disproportionately burdened by food insecurity and HIV, yet few tools examine how food environments influence diets. Understanding urban food acquisition patterns is essential for designing targeted interventions, particularly in rapidly urbanizing East Africa. This observational study (2019–2020) examined associations between food insecurity, household food purchases, and dietary adequacy among 312 adults living with HIV in peri-urban Dar es Salaam, Tanzania. Using an adapted 49-item food purchase tool, we conducted seven-day food purchase assessments and validated findings against 24-hour dietary recalls and micronutrient adequacy. Food environment interactions were defined as the frequency and diversity of purchases from formal, semi-formal, and informal vendors. Food-insecure households purchased more frequently than food-secure ones, and top purchases across households were tomatoes (62%), sugar (57%), beans (52%), carrots (50%), rice (48%), and maize flour (44%). Formal vendors dominated staples, while semi-formal and informal vendors provided the nutrient-dense foods. Meat purchase diversity predicted better zinc (OR: 1.2, P < 0.039) and vitamin A adequacy (OR: 1.2, P < 0.023). Latent class analysis identified three purchasing groups with differential associations with micronutrient adequacy. Findings highlight food-insecure households’ reliance on informal vendors and the need to preserve access to these critical sources.