Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0–51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI −3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

可靠地获得足够数量的安全和可接受的水（即水安全）对于药物依从性和限制病原体暴露非常重要，但先前的研究仅考虑了粮食安全作为艾滋病毒相关健康的社会决定因素的作用。因此，本分析的目的是评估肯尼亚西部艾滋病毒感染者 (N = 716) 的家庭用水不安全与艾滋病毒相关结果之间的关系。我们对Shamba Maisha (NCT02815579)的基线数据进行了横断面分析，这是一项多部门农业和资产贷款干预的整群随机对照试验。基线数据收集于 2016 年 6 月至 2017 年 12 月。我们评估了水不安全与艾滋病毒相关结果之间的关联，调整了临床和行为混杂因素，包括粮食不安全。家庭水不安全得分每提高五个单位（范围：0-51），病毒载量≥1000拷贝/mL的几率就会增加1.21（95% CI 1.07，1.36），患艾滋病定义疾病的几率就会增加1.26（ 95% CI 1.11, 1.42）。家庭用水不安全与 CD4 细胞计数无关（B：0.27；95% CI -3.59，13.05）。艾滋病毒治疗和支持计划应考虑评估和解决除粮食不安全之外的水不安全问题，以优化艾滋病毒治疗结果。