Shamba Maisha: Pilot Agricultural Intervention for Food Security and HIV Health Outcomes in Kenya
Condition: HIV; Malnutrition
MeSH terms: Malnutrition
Study type: Interventional

Summary: 
      This pilot study aims to determine whether an agricultural intervention will improve food
      security, prevent treatment failure, reduce co-morbidities, and decrease secondary HIV
      transmission risk among people living with HIV/AIDS. The intervention will include: a) a
      human-powered water pump and other required farm commodities, b) a micro-finance loan (~$75)
      to purchase the pump and agricultural implements, and c) education in sustainable farming
      practices.
    

Detailed description: 
      Food insecurity and HIV/AIDS are two leading causes of morbidity and mortality in sub-Saharan
      Africa and are inextricably linked. Since food insecurity contributes to increased HIV
      transmission risk and higher HIV-related morbidity and mortality, the World Health
      Organization (WHO), United Nations Programme on HIV/AIDS (UNAIDS), and the World Food
      Programme have recommended integrating sustainable food production strategies into HIV/AIDS
      programming. Yet, to date there have been few studies to systematically evaluate the impact
      of promising food security interventions on health, economic and behavioral outcomes among
      people living with HIV and AIDS. To address this gap, the investigators plan to test the
      hypothesis that a multi-sectoral agricultural intervention delivered in Nyanza Province,
      Kenya will prevent highly active antiretroviral (HAART) treatment failure, reduce
      co-morbidities, and decrease secondary HIV transmission risk. The intervention will include:
      a) a human-powered water pump and other required farm commodities, b) a micro-finance loan
      (~$75) to purchase the pump and agricultural implements, and c) education in sustainable
      farming practices. To develop our intervention, th investigators have formed an
      interdisciplinary collaboration with organizations in the healthcare, agriculture, and
      microfinance sectors. Our study aims include:

        1. The investigators will operationalize and pilot test key design elements of a future
           cluster randomized clinical trials (RCT) aimed to improve health outcomes among
           HAART-treated patients in Western Kenya. In conjunction with our collaborating partners,
           the investigators will develop the different components of the intervention, including:
           a) randomization procedures for cluster RCT using detailed site assessments; b)
           agricultural training protocols; c) procedures for control group; d) manual of
           operations.

        2. The investigators will conduct a pilot study of an agricultural intervention to
           determine the preliminary impact of the intervention on mediating outcomes (food
           security, and household economic indicators), and on primary health outcomes of interest
           for the planned RCT (HIV treatment outcomes, HIV transmission risk and women's
           empowerment). Up to one hundred and sixty HIV-infected farmers on HAART in Western Kenya
           (80 at an intervention clinic and 80 at a control clinic) will be enrolled and followed
           for 1 year. Impacts of our intervention on mediating and primary health outcomes will be
           investigated separately and jointly to provide a preliminary assessment of possible
           direct and indirect intervention effects.

        3. The investigators will assess the acceptability and feasibility of intervention and
           control conditions, and systematically translate lessons learned in the pilot study into
           the design of a cluster RCT. To accomplish Aim 3, the investigators will conduct a mixed
           methods process evaluation of the different intervention components and their
           implementation using quantitative, qualitative, and observational methods. The
           investigators will prepare an R01 grant for submission based on lessons learned. The
           ultimate goal of this work is to contribute to sustainable solutions to tackle the
           intersecting challenges of food insecurity, poverty, and HIV/AIDS in sub-Saharan Africa.

      The ultimate goal of this work is to contribute to sustainable solutions to tackle the
      intersecting challenges of food insecurity, poverty, and HIV/AIDS in sub-Saharan Africa.
    

Intervention name(s): Multi-sectoral agricultural intervention
Intervention type(s): Other
Intervention description(s): Participants in the intervention arm will receive a micro-finance loan and training on financial management and marketing skills. With the loan, each participant will receive vouchers to purchase the following items: the Money Maker hip pump, 50 feet of hosing, fertilizer, and government certified seeds. Participants in the intervention group will also receive training on the use of the Money Maker hip pump, a portable, low-cost, human-powered water pump developed by KickStart. Participants in the intervention group will also receive training from Kickstart on the use of the pump as well as complementary training in best horticultural practices.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: HIV; Malnutrition; Food Security; Kenya