AbstractObjective: Although undernutrition is recognized as a risk factor for mortalityamong people living with HIV (PLWHIV), even among those initiating antiretroviral therapy, few studies have explored the underlying determinants ofundernutrition. The objectives of the present study were to: (i) examine theindependent association between household food security, individual diet qualityand nutritional status; and (ii) determine if any association between food securityand nutritional status is mediated through diet quality.Design: Cross-sectional baseline survey.Setting: Gulu and Soroti districts, Uganda.Subjects: Nine hundred and two PLWHIV recruited into a study evaluating theimpact of a food assistance programme supported by the World Food Programme.Results: Food security and diet quality were measured using the Household FoodInsecurity Access Scale (HFIAS) and the Individual Dietary Diversity Score(IDDS), respectively. Multivariate regression results demonstrated that HFIAS andIDDS independently predict BMI (P , 0?01) and mid upper-arm circumference(P , 0?05). The adjusted odds ratio of being underweight (BMI , 18?5 kg/m2)among individuals living in severely food-insecure households was 1?92(P , 0?0 0 1); individuals consuming a highly diverse diet had an adjusted oddsratio of being underweight of 0?56 (P , 0?05) compared with those consuming adiet of low diversity. Similar results were observed when mid upper-arm circumference and wasting were modelled as outcomes. Using path analysis, weobserved that the indirect effect of food insecurity on BMI mediated throughdietary diversity is negligible, and mostly a result of the direct effect of foodinsecurity on BMI.Conclusions: Our results provide an empirical basis for focused efforts onimproving food access and diet quality among PLWHIV. Addressing the broaderstructural determinants of food security of people infected and affected by HIVis crucial.
