This study was a large, clustered-randomized trial conducted among 746 farmers living with HIV at 16 health facilities from 2016 to 2019. The study measured the impact of the multisectoral intervention among farmers on health outcomes. In addition, we sought to understand the pathways through which the intervention improved health outcomes among adults.
Background
HIV/AIDS and food insecurity are two leading causes of morbidity and mortality in sub-Saharan Africa (SSA) and are frequent intertwined through biological, behavioral and socioeconomic pathways.[1] Food insecurity increases risk of HIV acquisition,[2,3] and food-insecure HIV-infected individuals have worse adherence to antiretroviral therapy (ART) and clinic visits,[4] worse mental health,[5] and worse nutritional status,[1] all contributing to poor HIV treatment outcomes and increased morbidity and mortality.[6,7] In addition, persons living with HIV are susceptible to food insecurity and poverty and are least able to rely on social support for assistance when faced with health and agricultural shocks.
Prior Studies
- From 2007-2008, we demonstrated the feasibility of an income-generating micro-irrigation intervention among 30 HIV-positive patients in Kisumu.
- From 2012 to 2013, we carried out a pilot study of the intervention (PIs Cohen/Weiser) with 140 HIV-positive patients at two district hospitals in the Nyanza Region, one randomized to the intervention (n=72 participants) and one to the control arm (n=68 participants). We found a statistically significant increase in CD4+ cell counts and proportion virologically suppressed in the intervention arm compared with the control arm. Intervention participants also experienced significant improvements in food security and frequency of food consumption compared to controls.[1] A parallel study (PI Butler) was conducted with 200 children and their primary caregivers who resided in the households of the adults enrolled in the ‘parent’ study. Children who resided in intervention households had statistically significant gains in growth over a 1 year follow-up period.
Study Location
Our study is taking place in Kisumu, Migori, and Homa Bay Counties, Kenya
Study Design
We randomized eight matched pairs of health facilities in Kisumu, Migori, Homa Bay counties in Kenya in a 1:1 ratio to the intervention and control arms. Additional information regarding the study design is available at Clinicaltrials.gov (NCT02815579 and NCT03170986).
References
- Weiser, S.D., et al., Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. Am J Clin Nutr, 2011. 94(suppl): p. 1729S–39S.
- Weiser, S.D., et al., Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med, 2007. 4(10): p. 1589-97; discussion 1598.
- Tsai, A.C., K.J. Hung, and S.D. Weiser, Is food insecurity associated with HIV risk? Cross-sectional evidence from sexually active women in Brazil. PLoS Med, 2012. 9(4): p. e1001203.
- Young, S., et al., A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav, 2014. 18 Suppl 5: p. S505-15.
- Tsai, A.C., et al., Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med, 2012. 74(12): p. 2012-9.
- Weiser, S.D., et al., Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS, 2014. 28(1): p. 115-20.
- Weiser, S.D., et al., The association between food insecurity and mortality among HIV-infected individuals on HAART. J Acquir Immune Defic Syndr, 2009. 52(3): p. 342-9.