Pathways Linking Poverty, Food Insecurity, and HIV in Rural Malawi

马拉维农村地区贫困、粮食不安全和艾滋病毒之间的联系途径

• 批准号: 7795761
• 负责人: Lance S Weinhardt
• 金额: $ 49.03万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-04-03 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7795761
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Affect; Africa South of the Sahara; Agriculture; Area; Attitude; Autopsy; Back; Behavior; Behavioral; Birth; Capital; Caring; Cessation of life; Collaborations; Communities; Community Surveys; Control Groups; Country; Data; Development; Diffusion; Distal; Economics; Elements; Empirical Research; Environment; Environmental Risk Factor; Evaluation; Exposure to; Family member; Farming environment; Food; Funding; Gender; HIV; HIV Infections; Health; Health Benefit; Health Food; High Prevalence; Household; Human immunodeficiency virus test; Income; Individual; Interdisciplinary Study; International; Intervention; Interview; Knowledge; Language; Life; Life Expectancy; Link; Longitudinal Studies; Malawi; Malnutrition; Measurement; Measures; Mediator of activation protein; Medical; Modeling; NIH Program Announcements; Nature; Nutritional status; Outcome; Outcome Assessment; Participant; Pathway interactions; Patient Self-Report; Population; Postdoctoral Fellow; Poverty; Practice Management; Prevalence; Prevention; Prevention Research; Process; Production; Program Evaluation; Protocols documentation; Public Health; Quality of life; Recruitment Activity; Reporting; Research; Research Design; Risk; Risk Behaviors; Role; Rural; Savings; Schools; Security; Sentinel; Services; Site; Social Health Services; Societies; Source; Surveys; Sustainable Development; Testing; Textiles; Training; Translating; Trust; United States National Institutes of Health; Violence; Woman; base; cohesion; design; economic outcome; empowerment; farmer; feeding; follow-up; food security; improved; intervention effect; intervention program; member; men; nutrition; programs; public health relevance; response; risk perception; rural area; service intervention; skills; social; socioeconomics; theories; trend

DESCRIPTION (provided by applicant): This revised application is in response to PAR-06-114, "Research on Pathways Linking Environments, Behaviors and HIV/AIDS" and requests five years of support examine the relationship of HIV vulnerability to changes in economic environment and food security in rural Malawi. We have formed a multidisciplinary research team and partnered with CARE Malawi/USA to conduct three related studies: 1. We will conduct a quasi-experimental non-equivalent control group longitudinal study of the mechanisms, processes, and magnitude of impact of a large multi-level development and food security intervention (Improving Livelihoods through Increasing Food Security, or I-LIFE), as implemented by CARE Malawi, on HIV vulnerability (i.e., HIV risk behaviors, malnutrition, HIV infections, deaths due to HIV) and economic outcomes (i.e., food security, income, household assets). We will recruit participants from three types of areas of rural central Malawi: areas selected to receive the I-LIFE intervention from CARE, areas that will not receive I-LIFE but are participating in other CARE programming, and areas not receiving CARE programming during the life of the study. We will assess HIV-related, food security, and economic outcomes at both at the individual and community levels. In each of the CARE program areas, we will recruit 600 program participants and interview them at baseline and three yearly follow-ups to contrast I-LIFE participants directly with other CARE program recipients. We will examine broader changes at the community level, also hypothesized to result from the I-LIFE intervention, by conducting surveys with 1000 randomly-selected households in each of the 3 types of study areas at baseline and at a 36 month follow up. 2. We will conduct theory-based statistical analyses of longitudinal data collected in (1) to test pathways between socioeconomic changes, food security, HIV risk behavior, and HIV-related outcomes. 3. We will conduct a thorough qualitative end-of-program evaluation consisting of in-depth qualitative interviews with I-LIFE participants to understand the perceived impact of I-LIFE on their lives and the mechanisms of this impact. PUBLIC HEALTH RELEVANCE: The proposed research is directly relevant to public health by examining the effects of a multi-level intervention on HIV-related outcomes in Malawi, a country in sub-Saharan Africa with a high prevalence of HIV infection. In addition to examining the role of changes in economics and food security to HIV vulnerability, the proposed research will yield important information for determining the impact on HIV of multi-level environmental/structural interventions with the potential for sustainable long-term public health benefits, as well as for refining and improving the specific intervention under study for increased implementation.

说明(申请人提供)：本修订申请是对PAR-06-114《环境、行为和艾滋病毒/艾滋病联系途径的研究》的回应，并请求五年的支持，以审查马拉维农村地区艾滋病毒脆弱性与经济环境和粮食安全变化的关系。我们已经组成了一个多学科研究小组，并与CARE马拉维/美国合作进行了三项相关研究：1.我们将进行一项准试验性非对等对照小组纵向研究，以了解马拉维CARE实施的大规模多层次发展和粮食安全干预(通过增加粮食安全改善生计)对艾滋病毒脆弱性(即艾滋病毒风险行为、营养不良、艾滋病毒感染、艾滋病毒造成的死亡)和经济结果(即粮食安全、收入、家庭资产)的影响的机制、过程和规模。我们将从马拉维中部农村的三类地区招募参与者：被选中接受CARE的i-Life干预的地区，不接受i-Life但正在参加其他CARE方案的地区，以及在研究期间没有接受CARE方案的地区。我们将在个人和社区两个层面评估与艾滋病毒有关的、粮食安全和经济成果。在每个关怀计划领域，我们将招募600名计划参与者，并对他们进行基线访谈和三年一次的随访，以直接将I-Life参与者与其他关怀计划接受者进行对比。我们将考察社区层面更广泛的变化，假设也是i-Life干预的结果，在基线和36个月的跟踪调查中，在三种类型的研究区域中的每一种随机选择的1000户家庭进行调查。2.我们将对(1)中收集的纵向数据进行基于理论的统计分析，以检验社会经济变化、食品安全、艾滋病毒风险行为和艾滋病毒相关结果之间的路径。3.我们将对I-LIFE参与者进行全面的定性评估，包括深入的定性访谈，以了解I-LIFE对他们生活的感知影响以及这种影响的机制。公共卫生相关性：拟议的研究通过检查多层次干预对马拉维艾滋病毒相关结果的影响，与公共卫生直接相关，马拉维是撒哈拉以南非洲艾滋病毒感染率较高的国家。除了审查经济和粮食安全的变化对艾滋病毒脆弱性的作用外，拟议的研究还将提供重要信息，以确定具有可持续长期公共卫生惠益的多层次环境/结构干预措施对艾滋病毒的影响，以及完善和改进正在研究的具体干预措施，以加强实施。