Pilot Agricultural Intervention for Food Security and HIV Outcomes in Kenya

肯尼亚粮食安全和艾滋病毒成果试点农业干预

• 批准号: 8321451
• 负责人: CRAIG R COHEN
• 金额: $ 19万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-17 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8321451
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adherence; Adoption; Adult; Affect; Africa South of the Sahara; Agriculture; Anti-Retroviral Agents; Behavioral; Caregiver Burden; Caring; Clinic; Clinical; Comorbidity; Control Groups; Country; Data; Economics; Education; Effectiveness of Interventions; Elements; Enrollment; Epidemic; Ethical Review; Evaluation; Family; Farming environment; Food; Funding; Future; Goals; Grant; HIV; HIV Seropositivity; Health; Healthcare; Highly Active Antiretroviral Therapy; Hip region structure; Household; Human; Immunologics; Individual; International; Intervention; Kenya; Learning; Life; Link; Manuals; Mediating; Methods; Morbidity - disease rate; Occupational activity of managing finances; Occupations; Outcome; Participant; Patients; Pilot Projects; Play; Population; Poverty; Predisposition; Procedures; Process; Production; Protocols documentation; Province; Pump; Randomized; Randomized Controlled Trials; Risk; Role; Rural Population; Site; Solutions; Technology; Testing; Training; Translating; Treatment Failure; Treatment outcome; Water; Woman; Work; base; behavioral health; design; economic outcome; empowerment; experience; farmer; food challenge; food security; health economics; high risk; improved; informant; interdisciplinary collaboration; interest; intervention effect; member; mortality; operation; poverty reduction; prevent; programs; response; success; transmission process

DESCRIPTION (provided by applicant): 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 WHO, 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, we 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 microfinance loan (~$75) to purchase the pump and agricultural implements, and c) education in sustainable farming practices. To develop our intervention, we have formed an interdisciplinary collaboration with organizations in the healthcare, agriculture, and microfinance sectors. To improve our likelihood of success in a future cluster randomized control trial (RCT), we propose three specific aims for a 3-year R34 pilot study. In Aim 1 we will operationalize and pilot test key design elements of a future cluster RCT aimed to improve health outcomes among HAART-treated patients in Western Kenya. In conjunction with our collaborating partners, we 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. In Aim 2 we 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). One hundred and twenty HIV-infected farmers on HAART in Western Kenya (60 at an intervention clinic and 60 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. In Aim 3 we 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, we will conduct a mixed methods process evaluation of the different intervention components and their implementation using quantitative, qualitative, and observational methods. We 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.

描述（由申请人提供）：粮食不安全和艾滋病毒/艾滋病是撒哈拉以南非洲发病率和死亡率的两个主要原因，并且有密不可分的联系。由于粮食不安全有助于增加HIV传播风险和更高的与HIV相关的发病率和死亡率，因此WHO，UNAID和世界粮食计划计划建议将可持续的粮食生产策略纳入HIV/AIDS计划。然而，迄今为止，很少有研究可以系统地评估有希望的粮食安全干预措施对艾滋病毒和艾滋病患者中健康，经济和行为结果的影响。为了解决这一差距，我们计划检验以下假设：肯尼亚Nyanza省提供的多部门农业干预措施将防止高度活跃的抗逆转录病毒（HAART）治疗失败，降低合并症和降低中期HIV传播风险。干预措施将包括：a）人力动力的水泵和其他必需的农产品，b）小额信贷贷款（约75美元），用于购买泵和农业工具，c）在可持续农业实践中进行教育。为了发展干预措施，我们与医疗保健，农业和小额信贷部门的组织建立了跨学科的合作。为了提高我们在未来的群集随机对照试验（RCT）中取得成功的可能性，我们提出了三年的R3年R34初步研究的三个特定目标。在AIM 1中，我们将在未来的RCT中进行操作和试点测试的关键设计元素，该元素旨在改善肯尼亚西部HAART治疗的患者的健康状况。与我们的合作合作伙伴一起，我们将开发干预的不同组成部分，包括：a）使用详细站点评估的群集RCT的随机化程序； b）农业培训方案； c）对照组的程序； D）手册。在目标2中，我们将对农业干预措施进行试点研究，以确定干预措施对中介结果（粮食安全和家庭经济指标）的初步影响，以及对计划中的RCT（HIV治疗结果，艾滋病毒传播风险和赋予妇女赋予的艾滋病毒治疗结果和赋予妇女赋予的原始健康结果）。肯尼亚西部HAART的一百二十名HIV感染的农民（在干预诊所的60名和对照诊所的60个）被招募，并遵循1年。我们的干预对中介和初级健康结果的影响将分别研究，共同研究，以对可能的直接和间接干预效果进行初步评估。在AIM 3中，我们将评估干预和控制条件的可接受性和可行性，并系统地将试点研究中学到的经验教训转化为群集RCT的设计。为了完成目标3，我们将使用定量，定性和观察方法对不同干预组件进行混合方法的过程评估及其实施。我们将根据学习的教训为提交准备R01赠款。这项工作的最终目标是为可持续解决方案做出贡献，以应对撒哈拉以南非洲的粮食不安全，贫困和艾滋病毒/艾滋病的相交挑战。