Abstract:
ntroduction The relationship between food insecurity
and access to healthcare in low-resource settings remains
unclear. Some studies find that food insecurity is a barrier
to accessing care, while others report that food insecurity
is associated with a greater need for care, leading to more
care utilisation. We use data from the Harambee study in
western Kenya to assess the association between food
insecurity and difficulty accessing care among people
living with HIV (PLWH) with or without comorbid non-
communicable diseases (NCDs).
Methods The Harambee study is a cluster randomised
trial that tested the effectiveness of delivering integrated
HIV and NCD care for PLWH. In this cross-sectional
analysis, we examined baseline data from Harambee
participants to investigate the relationship between
household food insecurity and difficulty accessing care,
using multivariable logistic regression models, controlling
for sociodemographic factors and care satisfaction. We
tested for effect measure modification by gender and
household wealth and stratified analyses by NCD status.
Results Among 1039 participants, 11.1% reported
difficulty accessing care, and 18.9% and 51.9% of
participants had moderate and severe food insecurity,
respectively. Among those with difficulty accessing care,
73.9% cited transportation issues as the major barrier.
Difficulty accessing care was greater with higher levels of
food insecurity: among participants with low, moderate and
severe food insecurity, 5.9%, 9.7% and 14.4% reported
difficulty accessing care, respectively. After adjusting for
confounders, severe food insecurity was independently
associated with difficulty accessing care (adjusted OR=2.5,
95% CI 1.4 to 4.4). There was no statistical evidence for
effect measure modification by gender or wealth.
Conclusions We found that greater food insecurity was
associated with greater difficulty accessing care among
PLWH with or without NCDs in rural western Kenya. These
findings suggest that addressing social determinants of
health may be necessary when implementing integrated
HIV and NCD care programmes.