{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T23:34:00Z","timestamp":1773876840473,"version":"3.50.1"},"reference-count":30,"publisher":"International Union Against Tuberculosis and Lung Disease","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["public health action"],"accepted":{"date-parts":[[2025,12,2]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Adherence to antiretroviral therapy (ART) is crucial for the clinical management of people living with HIV (PLHIV), but food insecurity can compromise it. The threshold at which food insecurity significantly affects adherence remains poorly studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted in health care facilities in Kinshasa among 506 PLHIV receiving outpatient ART. Socio-demographic, clinical, behavioural, and nutritional data were collected through structured interviews and medical record reviews. Chi-square tests and logistic regression analyses were performed using Stata version 17.0 software, with a statistical significance threshold set at\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Proportion of ART nonadherence was 51.4%. Overall, 74.9% of participants were food insecure, including 56.5% with severe food insecurity. In multivariate analysis, severe food insecurity was strongly associated with nonadherence (adjusted odds ratio [aOR] = 5.98). Other predictors included alcohol use (aOR = 1.93), absence of viral load monitoring (aOR = 1.63), travel outside Kinshasa (aOR = 3.52), and being widowed or divorced (aOR = 2.18). ART refill intervals of 3\u20136 months were protective (aOR = 0.42).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>Severe food insecurity significantly undermines ART adherence. Integrating targeted nutritional support into HIV programmes, alongside biomedical care, may help improve treatment adherence and support progress towards achieving the UNAIDS 95-95-95 goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5588\/pha.25.0043","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T16:09:03Z","timestamp":1773850143000},"page":"3-7","source":"Crossref","is-referenced-by-count":0,"title":["Critical level of food insecurity and nonadherence to antiretroviral therapy among adults living with HIV"],"prefix":"10.5588","volume":"16","author":[{"given":"N.L.","family":"Mbiki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.S.","family":"Dimfumu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.E.","family":"Disuemi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.M.","family":"Ngombua","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.B.","family":"Bindamba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"K.T.","family":"Totokani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"G.D.","family":"Nahimana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"B.P.","family":"Mutombo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"3554","published-online":{"date-parts":[[2026,3,1]]},"reference":[{"key":"2026031809085748000_16.1.3.1","unstructured":"UNAIDS . Global HIV & AIDS statistics - 2024 fact sheet. Geneva, Switzerland: UNAIDS, 2024. https:\/\/www.unaids.org\/en\/resources\/fact-sheet."},{"key":"2026031809085748000_16.1.3.2","unstructured":"Ministry of Planning and Monitoring of the Implementation of the Revolution of Modernity, Ministry of Public Health (MSP), ICF International . Demographic and health survey in the Democratic Republic of Congo 2023-2024. Rockville, MD, USA: MPSMRM, MSP, and ICF International, 2024."},{"key":"2026031809085748000_16.1.3.3","unstructured":"Ministry of Public Health National AIDS Control Program . Annual report of the national AIDS control program 2022. Kinshasa, Democratic Republic of the Congo: PNLS, 2022."},{"key":"2026031809085748000_16.1.3.4","unstructured":"World Health Organization . HIV\/AIDS fact sheet. 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Rome, Italy: FAO, 2023."},{"key":"2026031809085748000_16.1.3.8","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-014-0873-1"},{"key":"2026031809085748000_16.1.3.9","doi-asserted-by":"publisher","DOI":"10.3945\/jn.109.105064"},{"key":"2026031809085748000_16.1.3.10","first-page":"1599","article-title":"Food insecurity and antiretroviral therapy adherence: a systematic review","volume":"23","author":"Chen","year":"2019","journal-title":"AIDS Behav"},{"issue":"3","key":"2026031809085748000_16.1.3.11","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1111\/j.1548-1387.2010.01109.x","article-title":"\u201cAll I eat is ARVs\u201d: the paradox of AIDS treatment interventions in Central Mozambique","volume":"24","author":"Kalofonos","year":"2010","journal-title":"Med Anthropol"},{"key":"2026031809085748000_16.1.3.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2012.02.033"},{"key":"2026031809085748000_16.1.3.13","unstructured":"Singer M . 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Rome, Italy: FAO, 2013."},{"key":"2026031809085748000_16.1.3.17","first-page":"1039","article-title":"Food insecurity is associated with increased risk of nonadherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study","volume":"14","author":"Musumari","year":"2014","journal-title":"BMC Public Health"},{"key":"2026031809085748000_16.1.3.18","first-page":"205","article-title":"Factors associated with treatment adherence among people living with HIV receiving antiretroviral therapy in Kinshasa, DRC","volume":"69","author":"Numbi","year":"2021","journal-title":"J Epidemiol Public Health"},{"key":"2026031809085748000_16.1.3.19","first-page":"25","article-title":"Prevalence of food insecurity among HIV positive adults accessing antiretroviral therapy in Harare, Zimbabwe","volume":"10","author":"Mupambireyi","year":"2013","journal-title":"SAHARA J"},{"key":"2026031809085748000_16.1.3.20","first-page":"431","article-title":"Food insecurity and sexual risk behavior among HIV-infected individuals in an urban area of the United States","volume":"15","author":"Weiser","year":"2011","journal-title":"AIDS Behav"},{"issue":"Suppl 5","key":"2026031809085748000_16.1.3.21","doi-asserted-by":"crossref","first-page":"S554","DOI":"10.1007\/s10461-014-0822-z","article-title":"Food security and nutrition interventions in response to the AIDS epidemic: assessing global action and evidence","volume":"18","author":"Aberman","year":"2014","journal-title":"AIDS Behav"},{"issue":"1","key":"2026031809085748000_16.1.3.22","first-page":"3","article-title":"Food insecurity and HIV: a systematic review of food assistance programs and their impact on adherence to antiretroviral therapy","volume":"21","author":"Young","year":"2017","journal-title":"AIDS Behav"},{"key":"2026031809085748000_16.1.3.23","first-page":"1081","article-title":"Adherence to antiretroviral therapy: impact on clinical outcomes and drug resistance","volume":"9","author":"Ortego","year":"2011","journal-title":"Expert Rev Anti Infect Ther"},{"key":"2026031809085748000_16.1.3.24","first-page":"515","article-title":"Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in resource-poor settings","volume":"19","author":"Wagner","year":"2015","journal-title":"AIDS Behav"},{"key":"2026031809085748000_16.1.3.25","first-page":"329","article-title":"Adherence to antiretroviral treatment and associated factors among people living with HIV in Nekemte Hospital, eastern Ethiopia","volume":"28","author":"Tiyou","year":"2010","journal-title":"J Health Popul Nutr"},{"key":"2026031809085748000_16.1.3.26","doi-asserted-by":"crossref","unstructured":"International Monetary Fund . 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