Social Determinants of Health
Co-infections and Related Conditions (CRC)
CTN 264 is exploring the risk factors of food insecurity and consequences of being food insecure in people living with HIV-HCV co-infection. To date, the study investigators have estimated the prevalence and severity of food insecurity within this population and identified potential risk factors for food insecurity in this context. They are also in the process of investigating how food insecurity impacts specific HIV-related clinical outcomes (e.g., CD4 cell counts and HIV viral load suppression).
Food insecurity (FI) exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain” (e.g., without resorting to emergency food supplies, scavenging, stealing, and other strategies). FI is associated with poorer health outcomes (sub-optimal treatment adherence) for people living with HIV. Chronic hepatitis C (HCV) infection in combination with HIV may further contribute to FI-related health and treatment complications.
CTN 264 is a sub-study of the Canadian Co-infection Cohort (CTN 222), a national cohort that tracks over 1500 Canadian participants who live with HIV-HCV. The food security sub-study recruited participants from CTN 222. Using a measurement tool created by Health Canada, participants were asked to complete a questionnaire to measure their food security status. Various social, economic, behavioral, and clinical variables are being used to identify risk factors for FI and explore outcomes associated with being food insecure over time.
Preliminary analyses of these data revealed that 59% of participants (312 of 525) were food insecure at their first study visit. Recent injection drug use (in the past 6 months) was significantly associated with food insecurity and approximately one third of study participants had recently injected drugs. The largest effect on food insecurity was observed for trading food to obtain tobacco, personal/household items, or drugs. The recent occurrence of depressive symptoms was also significantly associated with FI and roughly one half of participants experienced such symptoms.
To date, CTN 264 has helped identify potential targets for intervention and future research areas that may help reduce FI in HIV-HCV co-infected populations. As further analyses are completed, our understanding of the relationship between FI and HIV-HCV co-infection will continue to grow.
HepCBC Bulletin (page 3)
Positive Living Magazine (page 23)