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

描述（由申请人提供）：此修订后的申请是为了回应PAR-06-114，“研究路径连接环境，行为和艾滋病毒/艾滋病”，并要求五年的支持审查艾滋病毒的脆弱性的关系，在马拉维农村经济环境和粮食安全的变化。我们成立了一个多学科的研究团队，并与CARE马拉维/美国合作进行了三项相关研究：1。我们将进行一项准实验性非等效对照组纵向研究，研究由马拉维援外社实施的大型多层次发展和粮食安全干预措施（通过增加粮食安全改善生计，或I-LIFE）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、艾滋病毒导致的死亡）和经济结果（即，粮食安全、收入、家庭资产）。我们将从马拉维中部农村的三种类型的地区招募参与者：选择从CARE接受I-LIFE干预的地区，将不接受I-LIFE但正在参与其他CARE方案的地区，以及在研究期间不接受CARE方案的地区。我们将在个人和社区两级评估与艾滋病毒有关的粮食安全和经济成果。在每个CARE计划领域，我们将招募600名计划参与者，并在基线和三年一次的随访中对他们进行访谈，以直接将I-LIFE参与者与其他CARE计划接受者进行对比。我们将研究更广泛的变化，在社区层面上，也假设导致I-LIFE干预，进行调查，随机选择1000户家庭在每3种类型的研究领域在基线和36个月的后续行动。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、HIV风险行为和HIV相关结果之间的路径。3.我们将进行一个彻底的定性结束程序评估，包括深入定性访谈I-LIFE参与者，以了解I-LIFE对他们的生活和这种影响的机制感知的影响。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（艾滋病毒感染率高的撒哈拉以南非洲国家）艾滋病毒相关结果的影响，与公共卫生直接相关。除了审查经济和粮食安全变化对艾滋病毒脆弱性的作用外，拟议的研究将产生重要的信息，以确定具有可持续长期公共卫生惠益潜力的多层次环境/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，以加强执行。

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.