Food insecurity and its contributing factors among people living with HIV attending antiretroviral therapy in Addis Ababa, Ethiopia: a mixed-methods study

Despite growing evidence that food insecurity and HIV/AIDS are interlinked in a vicious cycle exacerbating each other through nutritional deficiencies, psychological stress, and risk behaviors there remains a significant gap in understanding the specific factors contributing to food insecurity among patients on highly active anti-retroviral therapy. In Ethiopia, it ranges from 55% to 84.5% and can cause immunologic deterioration, as well as increased morbidity and death in individuals who are already afflicted. Therefore; this study was aimed to assess food insecurity and its contributing factors among people living with HIV at Public hospitals in Addis Ababa, Ethiopia. A convergent parallel design mixed approach facility based cross sectional study was conducted among randomly selected 564 study participants determined using a single population proportion formula at public Hospitals in Addis Ababa. Systematic sampling method was used for the quantitative study while purposive sampling was used for the qualitative study. The focus group discussion and interview guide was used to collect the qualitative data. The household food insecurity Access Scale was used to measure household food insecurity. Thematic analysis was conducted for the qualitative study. Logistic regression model used to identify the factors associated with food insecurity. Variables with a P-value less than 0.05 in multivariable analysis were declared as statistically significant. The magnitude of food insecurity was 39.0% (95% CI: 34.9%, 42.9%). Among them, 53.6%, 35.9% and 10.5% have mild, moderate and sever food insecurity respectively. In multivariable analysis, CD4 cell count < 350 (AOR: 5.68; 95%CI: 3.18, 10.18), clinical stage III (AOR: 5.16; 95%CI: 2.35, 11.33), clinical stage IV (AOR: 3.39; 95%CI: 1.75, 6.55), opportunistic infection within the last six months (AOR: 2.94; 95%CI: 1.79, 4.81), being bedridden (AOR: 5.46; 95%CI: 2.72, 10.93) and poor treatment adherence (AOR: 7.40; 95%CI: 4.36, 12.57) were declared as statistically significant. Effect of ART Adherence, emotional and psychological effects, physical health effects, prioritizing family over personnel needs and financial constraints were the contributing factors explored using qualitative study. Together, the integrated evidence highlights that food insecurity among PLHIV is not only a matter of economic deprivation but also deeply connected to clinical status, mental health, and adherence behaviors, underscoring the need for comprehensive interventions addressing both biomedical and social factors. Food insecurity is a significant concern among people living with HIV. Low CD4 count, advanced clinical stage, opportunistic infections, reduced mobility, and poor treatment adherence were associated with higher risk. HIV care programs should integrate routine nutrition assessment, counseling, and targeted food support, especially for those with advanced disease or poor adherence.