Perceived impacts of a pilot agricultural livelihood and microfinance intervention on agricultural practices, food security and nutrition for Kenyans living with HIV.
Perceived impacts of a pilot agricultural livelihood and microfinance intervention on agricultural practices, food security and nutrition for Kenyans living with HIV.
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DOI：
10.1371/journal.pone.0278227
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Weiser, Sheri D.
中科院分区：
文献类型：
--
作者：
Nicastro, Tammy M.;Pincus, Lauren;Weke, Elly;Hatcher, Abigail M.;Burger, Rachel L.;Lemus-Hufstedler, Emiliano;Bukusi, Elizabeth A.;Cohen, Craig R.;Weiser, Sheri D.
农业是包括艾滋病毒携带者在内的75%肯尼亚农村人的主要收入来源和家庭食品，这使得农业产量成为粮食安全和营养的重要因素。以前的研究通过阐明患有这些疾病之一会增加发生另一种疾病的可能性和严重性，从而表明了粮食不安全、营养不良和艾滋病毒健康状况不佳之间的相互联系。然而，很少有研究探讨农业做法、粮食安全和艾滋病毒营养之间的联系，或者农业生计干预措施如何影响这些领域。这项研究旨在研究农业生计干预可以对农业实践、粮食安全和艾滋病病毒的营养产生积极或消极影响的机制。2012年7月至2013年8月，我们采访了参加农业生计和财政干预试点随机对照试验(RCT)的艾滋病毒感染者，以了解干预可能影响艾滋病毒健康结局的机制。干预措施包括农业和金融培训，以及一笔小额贷款，用于购买赚钱的HIP泵、人力水泵、种子和其他农具。有目的的45个干预样本和9个对照参与者的随机子集在12个月的终访时被采访，31名干预参与者的子集在3个月和12个月的访问中被纵向采访。使用归纳-演绎方法对成绩单进行双重编码，并使用每个关键主题的分析报告分析干预措施对农业实践、粮食安全和营养的影响。所有干预参与者都描述了由于干预而导致的农业做法和产量的改善，许多人还描述了收入的改善；这些变化反过来有助于改善艾滋病毒健康，包括抑制病毒载量，少数人注意到免疫学参数的改善。关键机制包括从农业培训中获得的知识，这些知识有助于提高产量和进入新市场。灌溉泵的使用也被认为是另一种不太重要的机制。所有干预参与者都报告说，通过增加用于购买粮食的过剩作物的产量和销售收入，以及通过农业生产消费新鲜水果和蔬菜的多样化，粮食安全和营养状况持续改善。这导致了自我报告的体重增加，这是一种改善健康的营养机制。改善耕作做法的农业和财政干预措施可通过改善粮食安全、收入和多样化饮食等途径改善健康结果。这项研究的结果帮助团队在实施更大的集群随机对照试验(CRCT)之前加强了干预。通过了解农业生计干预措施如何作用于改善健康的途径，可以制定和实施政策选择，以包括实现可持续成果所需的组成部分。临床试验.gov NCT01548599。
Agriculture is the primary source of income and household food for >75% of rural Kenyans, including people living with HIV (PLHIV), making agricultural yields an important factor in food security and nutrition. Previous studies have shown the interconnectedness of food insecurity, malnutrition, and poor HIV health by elucidating that having one of these conditions increases the likelihood and severity of having another. However, few studies have explored the linkages between agricultural practices, food security and nutrition for PLHIV, or how agricultural livelihood interventions may affect these domains. This study aimed to examine the mechanisms through which an agricultural livelihood intervention can positively or negatively affect agricultural practices, food security, and nutrition for PLHIV. From July 2012-August 2013, we interviewed participants with HIV on antiretroviral therapy (ART) enrolled in a pilot randomized controlled trial (RCT) of an agricultural livelihood and finance intervention to understand the mechanisms through which the intervention may have affected HIV health outcomes. The intervention included agricultural and finance training and a microfinance loan to purchase the MoneyMaker hip pump, a human-powered water pump, seeds, and other farming implements. A purposive sample of 45 intervention and a random subset of 9 control participants were interviewed at 12-month endline visit with a subset of 31 intervention participants interviewed longitudinally at both the 3- and 12-month visits. Transcripts were double coded using an inductive-deductive approach and analyzed for impacts of the intervention on agricultural practices, food security, and nutrition using analytic reports for each key theme. All intervention participants described improvements in agricultural practices and yields attributed to the intervention while many also described improvements in income; these changes in turn contributed to improved HIV health, including suppressed viral loads, and a few people noted improved immunologic parameters. Key mechanisms included the knowledge gained from agricultural training which led to improved yields and access to new markets. The use of the irrigation pump was also identified as an additional, lesser important mechanism. All intervention participants reported sustained improvements in food security and nutrition through increased yields and income from the sale of excess crops used to purchase food, and diversification of fresh fruits and vegetables consumed through agricultural production. This led to self-reported weight gain which was a nutritional mechanism towards improved health. Agricultural and finance interventions that improve farming practices could lead to improved health outcomes through the pathways of improved food security, income, and diversified diet. The results from this study helped the team to enhance the intervention prior to implementation of the larger cluster RCT (cRCT). By understanding how agricultural livelihood interventions act upon pathways towards improved health, policy options can be developed and implemented to include components that are needed to achieve sustainable outcomes. ClinicalTrials.gov NCT01548599.
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