@article{f076ec38426847a797956d62444e0993,
title = "Water Insecurity is Associated with Lack of Viral Suppression and Greater Odds of AIDS-Defining Illnesses Among Adults with HIV in Western Kenya",
abstract = "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.",
keywords = "AIDS, Food insecurity, Human immunodeficiency virus, Kenya, Water insecurity",
author = "Nagata, {Jason M.} and Miller, {Joshua D.} and Cohen, {Craig R.} and Frongillo, {Edward A.} and Elly Weke and Rachel Burger and Pauline Wekesa and Sheira, {Lila A.} and Mocello, {A. Rain} and Phelgona Otieno and Butler, {Lisa M.} and Bukusi, {Elizabeth A.} and Weiser, {Sheri D.} and Young, {Sera L.}",
note = "Funding Information: The research described was financially supported by the National Institutes of Mental Health under Grant 1R01MH107330 and the Competitive Research Grants to Develop Innovative Methods and Metrics for Agriculture and Nutrition Actions (IMMANA). IMMANA is funded with UK Aid from the UK government. SLY was supported by the Andrew Carnegie Fellows Program and the generous support of the American people provided to Rutgers University and the Feed the Future Sustainable Intensification Innovation Lab through the United State Agency for International Development Cooperative Agreement AID-OAA-L-14–00006 to SLY. The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the National Institutes of Health or the US Government. Funders of the study had no role in study design, data collection, data analysis, data interpretation or writing of the report. Authors had full access to all study data and had final responsibility for the decision to submit for publication. Funding Information: We thank the Kenyan women and men who generously gave their time to participate in the study. We acknowledge the important support of the Kenyan Medical Research Institute (KEMRI), the University of California, San Francisco (UCSF), and Global Programs for Research and Training (GPRT). We would also like to recognize the Director of KEMRI, the Director of KEMRI?s Centre for Microbiology Research, and the Kisumu, Homa Bay, and Migori County Ministries of Health for their support in conducting this research. We acknowledge the content expertise and support received from the UC Global Health Institute?s Center of Expertise in Women?s Health and Empowerment. We also thank Omar Sajjad, Bernard Rono, Brian Polo, Phoebe Olugo, Sylvia Atieno, Maureen Nyaura, Sylvia Akoko, Titus Arunga, Belinda Odhiambo, Richard Omondi, Elly Bwana, Emmanuel Otieno, Julie Omoro, Doreen Otieno, Rose Ngwengi, Amos Onyango, Sharon, Owour, Pius Atonga, Fredrick Ouko, Nicholas Ambira, George Kennedy, Geoffery Ojuok, Risper Omollo, Elija Mbaja, Valiant Odhiambo, Peter Obando, and Julias Odhacha for their important contributions to this research. We thank Samuel Benabou and Ananya Rupanagunta for editorial assistance. Publisher Copyright: {\textcopyright} 2021, The Author(s).",
year = "2022",
month = feb,
doi = "10.1007/s10461-021-03410-w",
language = "English (US)",
volume = "26",
pages = "549--555",
journal = "AIDS and behavior",
issn = "1090-7165",
publisher = "Springer New York",
number = "2",
}
