Agricultural intervention for food security and HIV healthoutcomes in Kenya

 描述(由申请人提供)：尽管艾滋病毒携带者的护理和治疗取得了重大进展，但在撒哈拉以南非洲地区，艾滋病毒/艾滋病患者的发病率和死亡率仍然高得令人无法接受，这主要是由于贫困和粮食不安全的平行挑战。粮食不安全和贫困是艾滋病毒发病率和死亡率上升的原因，国际上越来越多地认识到，必须解决这些因素，才能在全球成功应对艾滋病毒流行病。然而，到目前为止，很少有研究系统地评估有希望的食品安全干预措施对艾滋病毒感染者健康结果的影响和成本效益。为了弥补这些差距，我们与设在南沙的非政府组织KickStart一起，在肯尼亚年扎地区开展了一项多部门干预行动，其中包括：a)提供小额贷款(约175美元)，用于购买农具和商品；b)贷款购买农具，包括人力水泵、种子、化肥和杀虫剂；c)开展财务管理和可持续耕作做法方面的教育。我们成功地完成了一项由美国国立卫生研究院资助的试点干预试验，该试验表明，该干预是可行的、可接受的，并可能改善艾滋病毒相关的健康。我们现在计划对这一干预措施进行一项整群随机对照试验，具体目标如下：AI 1：确定感染艾滋病毒的农民中的多部门农业干预对抗逆转录病毒治疗对艾滋病毒临床结果的影响。我们假设干预将改善病毒载量抑制(主要结果)，并降低干预组中与艾滋病毒相关的发病率。

 DESCRIPTION (provided by applicant): Despite major advances in care and treatment for those living with HIV, morbidity and mortality among people living with HIV/AIDS (PLHIV) remain unacceptably high in sub-Saharan Africa (SSA), largely due to the parallel challenges of poverty and food insecurity. Food insecurity and poverty contribute to higher morbidity and mortality among PLHIV, and there has been increasing international recognition of the need to address these factors for a successful global response to the HIV epidemic. Yet, to date there have been few studies to systematically evaluate the impact and cost-effectiveness of promising food security interventions on health outcomes among PLHIV. To address these gaps, together with KickStart, a non-governmental organization based in SSA, we have developed a multisectoral intervention in Nyanza Region, Kenya that includes: a) a microfinance loan (~$175) for purchasing agricultural implements and commodities; b) agricultural implements to be purchased with the loan including a human-powered water pump, seeds, fertilizers and pesticides; and c) education in financial management and sustainable farming practices. We successfully completed an NIH- funded pilot intervention trial that showed that the intervention was feasible, acceptable and may improve HIV- related health. We now plan to conduct a cluster randomized controlled trial (RCT) of this intervention with the following specific aims: Ai 1: To determine the impact of a multisectoral agricultural intervention among HIV- infected farmers on ART on HIV clinical outcomes. We hypothesize that the intervention will lead to improved viral load suppression (primary outcome) and decreased HIV-related morbidity in the intervention arm