HIV, Tuberculosis, and Food Insecurity in Africa-A Syndemics-Based Scoping Review

Abstract

The double burden of HIV/AIDS and tuberculosis (TB), coupled with endemic and problematic food insecurity in Africa, can interact to negatively impact health outcomes, creating a syndemic. For people living with HIV/AIDS (PWH), food insecurity is a significant risk factor for acquiring TB due to the strong nutritional influences and co-occurring contextual barriers. We aim to synthesize evidence on the syndemic relationship between HIV/AIDS and TB co-infection and food insecurity in Africa. We conducted a scoping review of studies in Africa that included co-infected adults and children, with evidence of food insecurity, characterized by insufficient to lack of access to macronutrients. We sourced information from major public health databases. Qualitative, narrative analysis was used to synthesize the data. Of 1072 articles screened, 18 articles discussed the syndemic effect of HIV/AIDS and TB co-infection and food insecurity. Reporting of food insecurity was inconsistent, however, five studies estimated it using a validated scale. Food insecure co-infected adults had an average BMI of 16.5-18.5 kg/m². Negative outcomes include death (n = 6 studies), depression (n = 1 study), treatment non-adherence, weight loss, wasting, opportunistic infections, TB-related lung diseases, lethargy. Food insecurity was a precursor to co-infection, especially with the onset/increased incidence of TB in PWH. Economic, social, and facility-level factors influenced the negative impact of food insecurity on the health of co-infected individuals. Nutritional support, economic relief, and psychosocial support minimized the harmful effects of food insecurity in HIV-TB populations. Interventions that tackle one or more components of a syndemic interaction can have beneficial effects on health outcomes and experiences of PWH with TB in Africa.

Keywords: Africa; HIV/AIDs; food insecurity; syndemics; tuberculosis.

Figure 1

PRISMA study flowchart. This chart shows the systematic screening of studies, using inclusion and exclusion criteria to advance or eliminate studies for the review. Two stages of screening occurred: first, titles and abstracts were screened for 1072 studies, excluding 842 records; second, full texts were retrieved and screened for 215 out of 230 studies. Of these 215 studies, 18 studies made it to the final review. * Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ** If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools.

Figure 2

(a) Risk of bias assessment of cross-sectional studies (n = 7). At least 75% of all cross-sectional studies had a low risk of bias across all indicators for the quality of evidence gathered in the studies. (b) Risk of bias assessment of cohort studies (n = 3). Two of the three cohort studies exhibited a low risk of bias across all indicators for assessing the quality of evidence for cohort studies. (c) Risk of bias assessment of qualitative studies (n = 2). Across all indicators for assessing the quality of evidence, 100% of the qualitative studies had a low risk of bias in the evidence reported. (d) Risk of bias assessment of a randomized implementation study (n = 1). The singular randomized study only had a low risk of bias for 3 indicators (allocation concealment, blinding of participants, and blinding of personnel) out of 7 total indicators for assessing the quality of evidence. (e) Risk of bias assessment of a mixed methods study (n = 1). The singular mixed methods study had a low risk of bias across all indicators for assessing the quality of evidence for this type of study design.

Figure 2

(a) Risk of bias assessment of cross-sectional studies (n = 7). At least 75% of all cross-sectional studies had a low risk of bias across all indicators for the quality of evidence gathered in the studies. (b) Risk of bias assessment of cohort studies (n = 3). Two of the three cohort studies exhibited a low risk of bias across all indicators for assessing the quality of evidence for cohort studies. (c) Risk of bias assessment of qualitative studies (n = 2). Across all indicators for assessing the quality of evidence, 100% of the qualitative studies had a low risk of bias in the evidence reported. (d) Risk of bias assessment of a randomized implementation study (n = 1). The singular randomized study only had a low risk of bias for 3 indicators (allocation concealment, blinding of participants, and blinding of personnel) out of 7 total indicators for assessing the quality of evidence. (e) Risk of bias assessment of a mixed methods study (n = 1). The singular mixed methods study had a low risk of bias across all indicators for assessing the quality of evidence for this type of study design.