LAUSR

An estimated 24% to 50% of people with HIV (PWH) in theUnited States are food insecure (Willig et al., 2018). In particular, the Southern United States accounts for 52% of new HIV diagnoses (Centers for DiseaseControl and Prevention, 2019;Reif et al., 2017), and the region is disproportionately affected by the dual burdens of HIV and food insecurity (Coleman-Jenson et al., 2019). Food insecurity, defined as the inability to obtain food in personally or socially acceptable ways (Coleman-Jenson et al., 2019), may negatively affect HIV treatment outcomes and the ability to manage chronic diseases (Kalichman et al., 2014; Weiser et al., 2009). Food insecurity affects the entire HIV care continuum from acquisition to viral suppression (Singer et al., 2015;Wang et al., 2011;Weiser et al., 2011). Food insecurity among PWH is associated with lower levels of antiretroviral therapy (ART) concentrations in hair and with two times higher HIV viral load, indicators of whether a patient is adhering to the HIV medication regimen (Leddy et al., 2020; Spinelli et al., 2017). Furthermore, patients have reported skipping HIV medication doses when they do not have enough food to take the medication with a full meal as sometimes instructed (Walcott et al., 2016). Alleviating food insecurity among PWH could thus positively affect ART adherence in this population. People with HIV with food insecurity in the United States are referred to standard federal or community-led food assistance programs (McKay et al., 2017). However, a recent systematic review of diet quality among food pantry beneficiaries reported diets were low in fruits, vegetables, and dairy products and provided inadequate amounts of fiber and several micronutrients (Simmet et al., 2017). Participation in food assistance programs thus can reduce food insecurity but may inadvertently increase chronic disease risk among program clients (Byker Shanks, 2017; Simmet et al., 2017). To address the burden of food insecurity in PWH, the University of Alabama at Birmingham 1917 Clinic and BirminghamAIDSOutreach (BAO) designed a nutrientrich food program tailored to nutritional and social needs of PWH. Here, we outline the development process for a novel, comprehensive food assistance program Wesli H. Turner, MSc, is Research Coordinator, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA, Emma Sophia Kay, PhD, is Director of Research and Development, Birmingham AIDS Outreach, Birmingham, Alabama, USA, James L. Raper, PhD, CRNP, JD, is Professor and Director of UAB 1917 HIV Outpatient Clinic, University of Alabama at Birmingham School ofMedicine, Birmingham,Alabama,USA,KarenMusgrove, PhD,MED, LPC, is Chief Executive Officer, BirminghamAIDSOutreach, Birmingham, Alabama, USA, KathyGaddis, LMSW, isDirector of SocialWork 1917Clinic,University of Alabamaat Birmingham School of Medicine, Birmingham, Alabama, USA, Anastasia Ferrell, BFA, is B-FED Fulfillment Coordinator, Birmingham AIDS Outreach, Birmingham, Alabama, USA, Donna Yester, MAE, RD, is a Registered Dietitian 1917 Clinic, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA, Joshua Glenn is the B-FED Nutrition Education Specialist, Birmingham AIDS Outreach, Birmingham, Alabama, USA, Meredith Atwater, RD, is a Registered Dietitian 1917 Clinic, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA, Kris Hutchins, LMSW, BSW, is Director of Client Services, Birmingham AIDS Outreach, Birmingham, Alabama, USA, Ashutosh Tamhane, MD, PhD, is Clinical Database Manager, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA, Dustin Long, PhD, is an Associate Professor, University of Alabama at Birmingham Department of Biostatistics, Birmingham,Alabama,USA,Polly Kellar, LPC, JD, isChiefCompliance Officer, BirminghamAIDSOutreach,Birmingham,Alabama,USA, TomCreger, PhD, is Quality Improvement Program Manager, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA, Ellen Eaton, MD, MSPH, is an Assistant Professor, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA, Amanda L. Willig, PhD, RD, is an Associate Professor, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.