Shamba Maisha: Pilot agricultural intervention for food security and HIV health outcomes in Kenya: design, methods, baseline results and process evaluation of a cluster-randomized controlled trial
Shamba Maisha: Pilot agricultural intervention for food security and HIV health outcomes in Kenya: design, methods, baseline results and process evaluation of a cluster-randomized controlled trial
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DOI：
10.1186/s40064-015-0886-x
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发表时间：
2015-03-12
期刊：
影响因子：
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通讯作者：
Weiser, Sheri D.
中科院分区：
文献类型：
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作者：
Cohen, Craig R.;Steinfeld, Rachel L.;Weiser, Sheri D.
背景资料：尽管艾滋病毒感染者的治疗进展，发病率和死亡率仍然不可接受的高，在撒哈拉以南非洲，主要是由于并行流行的贫困和粮食不安全。方法/设计：我们进行了一个试点集群随机对照试验（RCT）的多部门农业和小额信贷干预（题为香巴迈沙），旨在提高粮食安全，家庭财富，艾滋病临床结果和妇女赋权。干预在肯尼亚的两个艾滋病诊所进行，一个随机分配到干预组，另一个随机分配到对照组。18岁以上、接受抗逆转录病毒治疗、中度/重度粮食不安全和/或体重指数（BMI）< 18.5、能够获得土地和地表水的艾滋病感染者有资格入组。干预措施包括：1）小额贷款（约150美元），用于购买农产品; 2）微灌泵、种子和化肥; 3）可持续农业实践和金融知识培训。招募140名参与者需要四个月的时间，两组之间的筛选与招募比例相似。我们对参与者进行了12个月的跟踪调查，并进行了结构化问卷调查。我们还进行了一个过程中的评估与参与者和利益相关者3-5个月后，研究开始，并在studyend.Discussion：基线结果显示，参与者在两个网站的年龄，性别和婚姻状况相似。与对照研究中心的受试者相比，干预研究中心的受试者中BMI较低的比例更高（18% vs. 7%，p = 0.054）。虽然两组之间的中位CD 4计数相似，但与对照组相比，干预组招募的参与者中有更大比例的参与者具有可检测的HIV病毒载量（分别为49%和28%，p < 0.010）。过程评价结果表明，Shamba Maisha在招聘方面具有很高的可接受性，提供了强有力的农业和金融培训，并由于使用水泵而节省了劳动力。执行方面的挑战包括与会者对偿还贷款的关切、气候模式造成的农业挑战以及与小额供资机构的伙伴关系问题。我们期望这项试点研究的结果能够提供有关生计干预影响的有用数据，并有助于设计一个明确的整群随机对照试验。
Background: Despite advances in treatment of people living with HIV, morbidity and mortality remains unacceptably high in sub-Saharan Africa, largely due to parallel epidemics of poverty and food insecurity.Methods/Design: We conducted a pilot cluster randomized controlled trial (RCT) of a multisectoral agricultural and microfinance intervention (entitled Shamba Maisha) designed to improve food security, household wealth, HIV clinical outcomes and women's empowerment. The intervention was carried out at two HIV clinics in Kenya, one randomized to the intervention arm and one to the control arm. HIV-infected patients > 18 years, on antiretroviral therapy, with moderate/severe food insecurity and/or body mass index (BMI) < 18.5, and access to land and surface water were eligible for enrollment. The intervention included: 1) a microfinance loan (similar to$ 150) to purchase the farming commodities, 2) a micro-irrigation pump, seeds, and fertilizer, and 3) trainings in sustainable agricultural practices and financial literacy. Enrollment of 140 participants took four months, and the screening-to-enrollment ratio was similar between arms. We followed participants for 12 months and conducted structured questionnaires. We also conducted a process evaluation with participants and stakeholders 3-5 months after study start and at study end.Discussion: Baseline results revealed that participants at the two sites were similar in age, gender and marital status. A greater proportion of participants at the intervention site had a low BMI in comparison to participants at the control site (18% vs. 7%, p = 0.054). While median CD4 count was similar between arms, a greater proportion of participants enrolled at the intervention arm had a detectable HIV viral load compared with control participants (49% vs. 28%, respectively, p < 0.010). Process evaluation findings suggested that Shamba Maisha had high acceptability in recruitment, delivered strong agricultural and financial training, and led to labor saving due to use of the water pump. Implementation challenges included participant concerns about repaying loans, agricultural challenges due to weather patterns, and a challenging partnership with the microfinance institution. We expect the results from this pilot study to provide useful data on the impacts of livelihood interventions and will help in the design of a definitive cluster RCT.