Exploratory analysis of the effect of a food security intervention on alcohol use among people with HIV in the Dominican Republic.

Abstract

Food insecurity is associated with increased alcohol consumption among people living with HIV (PLHIV). Few studies have explored whether interventions to reduce food insecurity might also mitigate alcohol use. We examine whether a pilot urban gardens and peer nutritional counseling intervention ("ProMeSA") among PLHIV experiencing food insecurity in the Dominican Republic (DR) was associated with reduced alcohol consumption. We recruited 109 participants from two HIV clinics: 1 intervention clinic (n = 46) and 1 control clinic (n = 63). The 12-month intervention included training, materials, and support to establish and maintain a garden; peer nutritional counseling sessions; and a garden-based nutrition and cooking workshop. Survey-based measures included a standard measure of alcohol use (AUDIT-C) and hazardous drinking derived from the AUDIT-C score. Intervention effects were analyzed using a differences-in-differences approach implemented via longitudinal multivariable regression accounting for serial cluster correlation. At baseline, the mean AUDIT score was 2.35, indicating low-risk for problematic drinking on average; however, one-third (34%) reported hazardous drinking. Between baseline and 6 months, AUDIT scores decreased by 0.6-points on average (p = 0.155; 95% CI: -1.45, 0.23) and the prevalence of hazardous drinking decreased by 11 % points (p = 0.146; 95% CI: -0.27, 0.04) in the intervention group compared to the control group. At 12 months, average alcohol use was lower for both intervention and control participants. Addressing food insecurity through urban gardening and peer nutritional counseling may decrease alcohol consumption among PLHIV. Larger trials are needed to confirm effects and examine if they are sustained across settings and timeframes.