Tulsa CARES Partners with University of Oklahoma Health Sciences Center for New Food as Medicine Study to Address Food Insecurity and other Root Causes of Insulin Resistance in HIV/AIDS

Tulsa CARES is partnering with researchers at the Hudson College of Public Health at the University of Oklahoma Health Sciences Center and the OU-TU School of Community Medicine at the University of Oklahoma to develop and test a novel "food as medicine" intervention for individuals affected by HIV/AIDS.

Founded in 1991 as a planned community response to the HIV epidemic, Tulsa CARES is northeastern Oklahoma's largest HIV social services organization. Its food assistance programs provided more than 2,000 prepared meals and nearly 10,000 bags of groceries to 487 Oklahomans living with HIV in 2019. Tulsa CARES is now also the lead community collaborator for the Nutrition to Optimize, Understand, and Restore Insulin Sensitivity in HIV for Oklahoma (NOURISH-OK) Study, a community-based participatory research project.

Additional academic research collaborators include investigators from the OU Tulsa Integrative Immunology Center, the Harold Hamm Diabetes Center, Oklahoma State University Center for Health Sciences, the University of California San Francisco, and Connecting Health Innovations, LLC in Columbia, South Carolina.

Marianna Wetherill, PhD, MPH, RDN-AP/LD, is the Principal Investigator of the NOURISH-OK Study, a $2.46 million R01 grant awarded by The National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Wetherill is an Associate Professor and the George Kaiser Family Foundation Chair in Population Healthcare at the University of Oklahoma Tulsa Schusterman Center. She is jointly appointed at the OU Hudson College of Public Health, Department of Health Promotion Sciences and the OU-TU School of Community Medicine, Department of Family & Community Medicine. In 2013, Wetherill partnered with Oklahoma's medical and social service providers to conduct the first statewide assessment of food insecurity in Oklahoma's HIV community.

"Food insecurity is a very common problem for people living with HIV disease in Oklahoma," said Wetherill. "While food insecurity affects nearly one in six households in Oklahoma's general population, our previous research suggested that food insecurity affects four out of six low-income Oklahomans living with HIV. What's more disturbing is that the vast majority of individuals met the criteria for very low food security, which involves skipping meals, going hungry, or losing weight due to lack of food."

Surprisingly, patients with HIV experience higher rates of insulin resistance, a condition usually associated with chronic overconsumption of energy. Thus, this study will rigorously explore multiple aspects of diet, degree of food insecurity, and HIV-related health measures to help provide new insights into the underlying causes of dysglycemia in this high-risk population.

The NOURISH-OK Study will allow a team of interdisciplinary researchers to unpack complex relationships to discover why food insecurity is occurring at such high rates within Oklahoma's HIV community and how food insecurity may influence the development or aggravation of chronic co-morbidities in HIV, such as Type 2 diabetes. The study ultimately aims to identify sustainable, community-based solutions to address this problem of food insecurity in people living with HIV. Using an integrative health approach, researchers will investigate how various risk exposures, including childhood trauma and the current food environment, contribute to food insecurity. The team will also investigate how food insecurity and chronic inflammation relate to insulin resistance via diet, other health behaviors, and the microbiome. Food insecurity and insulin resistance are associated with inflammatory diets. The team hopes to identify those specific aspects of diet that may be driving risk and those that might offer protection.

"Community-based organizations play a very powerful role in shaping community health," said Kate Neary, MPH, Chief Executive Officer of Tulsa CARES. "We have much discretion in the selection of foods that we choose to emphasize and distribute through our nutrition programs, but rarely do we have the opportunity to participate in nutrition research. Our involvement with the NOURISH-OK Study will allow us to advance evidence-based delivery of food as medicine for people living with HIV."

The five-year project will begin enrolling new participants in early 2021, beginning first with a comprehensive assessment of 500 Oklahomans living with HIV, including an extensive survey, various biomarkers and body composition measures. A subsample of 100 participants will also provide salivary and stool samples for microbiome analyses. Researchers will use a technique called structural equation modeling to test the study's overall conceptual multi-level framework of food insecurity and insulin resistance. The team of community and academic researchers will then collect input from people living with HIV to adapt and test a "food as medicine" intervention designed to address key risk factors linked to food insecurity and insulin resistance. Tulsa CARES will then lead implementation efforts for the 12-week NOURISH-OK intervention involving 270 participants.

"What we appreciate most about this project is its heavy community involvement across multiple HIV stakeholders and service providers in both its design and implementation," said Neary. "As the HIV epidemic has evolved, so have the needs of our clients. Throughout this evolution, Tulsa CARES has remained committed to meeting the needs of the whole person. We are proud to serve as the lead community partner for this project as a reflection of that commitment."

"This study could not be possible without the commitment of Tulsa CARES," said Wetherill. "Public health performs at its best when the science is implemented in partnership with community stakeholders and with social work at the table."