Abstract:
Background: Undernutrition significantly affects the effectiveness and adherence to
antiretroviral therapy (ART), survival status and quality of life in people living with HIV.
Prevalence of undernutrition among HIV infected people in Ethiopia ranges from 12.3-55.6%.
Limited case-control studies conducted on this topic, and factors like food insecurity, dietary
diversity, depression and substance use were not adequately addressed.
Objective: To identify determinants of undernutrition among adult people on antiretroviral
therapy in Goba Hospital, Southeast Ethiopia.
Methods: A facility-based case-control study was conducted from March 16 to May 26, 2019.
Consecutive sampling method was used to select 92 cases and 184 controls. Cases were
undernourished (Body Mass Index (BMI) < 18.5 kg/m2) adult people living with HIV attending
antiretroviral therapy. Controls were well-nourished (BMI=18.5-24.9 kg/m2) adult people
living with HIV who are on antiretroviral therapy. A pretested structured questionnaire was
used to collect data by face-to-face interviewer and checklist was used collect clinical data from
medical records. Data were entered into Epi-data version 4.4 & then exported to SPSS version
23 for analysis. Bivariate logistic regression was computed and candidate variables with p≤0.20
were entered to multivariable logistic regression model. Absence of multicollinearity and
interaction was checked using variance inflation factor and Breslow-Day test of homogeneity
respectively. P-value <0.05 was considered statistically significant and Adjusted Odds Ratio
(AOR) at 95% Confidence Interval (CI) was used to assess the strength of association.
Results: Factors independently associated with undernutrition were household food insecurity
[AOR=3.24, 95% CI:(1.72–6.08)], having depression [AOR=2.07, 95% CI:(1.16–3.72)],
current alcohol consumption [AOR=3.80, 95% CI:(1.71–8.43)] and non-adherence to
antiretroviral therapy [AOR=2.61, 95% CI:(1.28–5.30)].
Conclusions: Household food insecurity, having depression, alcohol consumption and nonadherence
to ART were independently associated with undernutrition in adult PLHIV.
Integrating food insecurity interventions to HIV program at the hospital level is required.
Strategies and program targeting PLHIV need to consider psychosocial problem like
depression and alcohol consumption. Healthcare providers need to strengthen awareness
creation activity on adherence and psychosocial factors that can affect nutritional status of adult
PLHIV.
