Multi-Sectoral Agricultural Intervention to Improve Nutrition, Health, and Developmental Outcomes of HIV-infected and Affected Children in Western Kenya

多部门农业干预措施改善肯尼亚西部艾滋病毒感染和受影响儿童的营养、健康和发育成果

• 批准号: 9357689
• 负责人: Lisa Michelle Butler
• 金额: $ 61.28万
• 依托单位: UNIVERSITY OF CONNECTICUT STORRS
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-30 至 2021-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9357689
• 关键词: 5 year old; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Africa South of the Sahara; Age; Agreement; Agriculture; Area; Caregiver Burden; Caregivers; Caring; Child; Child Mortality; Child Nutrition; Child health care; Childhood; Clinical; Companions; Control Groups; Data; Development; Diet; Economics; Education; Effectiveness; Effectiveness of Interventions; Emergency Situation; Enrollment; Epidemic; Family; Farming environment; Female; Fertilizers; Food; Funding; Growth; HIV; Health; Health Care Costs; Health care facility; Height; Home environment; Hospitalization; Household; Household Products; Human; Income; Intervention; Intervention Studies; Kenya; Life; Malnutrition; Mental Health; Morbidity - disease rate; National Institute of Mental Health; Nutritional; Occupational activity of managing finances; Outcome; Parents; Participant; Pathway interactions; Patients; Pesticides; Plant Roots; Poverty; Pump; Randomized; Randomized Controlled Trials; Research Infrastructure; Resources; Role; Rural; Sample Size; Seeds; Support Groups; Testing; Time; Translating; Water; Weight; World Health Organization; antiretroviral therapy; arm; burden of illness; cost; cost effectiveness; design; disability weights; disability-adjusted life years; empowerment; follow-up; food security; group intervention; high risk; improved; incremental cost-effectiveness; interest; intervention effect; member; neurobehavioral; neurodevelopment; nutrition; physical conditioning; primary caregiver; primary outcome; public health relevance; response; scale up; secondary outcome

 DESCRIPTION (provided by applicant): HIV and AIDS has had a devastating effect on family food security and household wealth in sub-Saharan Africa through the debilitation of the most productive household members, decreased household income, and increased caregiver burden. Children under five living in households affected by HIV and AIDS are at particularly high risk for food insecurity and its subsequent negative impacts on nutrition and health outcomes. While there is widespread agreement that interventions to improve food security and reduce poverty may improve ongoing responses to the HIV epidemic, there is a dearth of evidence regarding the effectiveness of such interventions on the nutritional, health and neurobehavioral development outcomes of HIV-affected children. Such interventions are most needed in settings such as Nyanza Region in Western Kenya: a largely rural, agricultural area characterized by high levels of poverty, HIV, food insecurity, and child mortality. Here, we propose to leverage the infrastructure of a recently funded cluster randomized controlled trial (NIMH R01MH107330) designed to determine the effectiveness of a multisectoral agricultural intervention on improving HIV clinical and other health outcomes of HIV-infected adults in Western Kenya (the `parent study'). We propose to assess the impact of the intervention on nutrition, health, and neurobehavioral development outcomes for HIV-affected children. The parent study will include 8 matched pairs of health facilities, randomized in a 1:1 ratio to the intervention and control arms, enrolling 44 HIV-infected adult participants per facility (N=704 adults, 50% female) and followed for 2 years. The proposed study will enroll and follow all HIV- affected children (enrolled at age 6- to- 36 months) and their primary caregiver (age >18 years) who reside in compounds of participants in the parent study (1:1 ratio, intervention and control). The study will include a minimum of 352 children (n=176 per study arm) with their primary caregiver. Children's HIV status will be ascertained, and children will be assessed at regular intervals for two years for the outcomes of interest. Our specific aims are as follows: Aim 1: To determine the effect of the intervention on nutritional, health, and neurodevelopment outcomes of HIV-affected children under 5 years old. Aim 2: To understand the pathways through which the intervention may improve nutritional, health, and neurobehavioral development outcomes of HIV-affected children. Aim 3: To evaluate the incremental cost and cost-effectiveness of the intervention with respect to children's health outcomes (in coordination with the parent study's analysis for adults). By addressing the root causes of food insecurity and poverty, the intervention may contribute to improvements in child nutrition, health and neurobehavioral development. Our project is responsive to several priority areas of the President's Emergency Plan for AIDS Relief as well as those of the World Health Organization regarding care and treatment for children affected by HIV and AIDS. Results from the proposed study will provide the needed evidence to promote scale-up of an integrated, multisectoral approach, if it is shown to be effective.

 描述（由适用提供）：艾滋病毒和艾滋病通过衰弱的家庭成员的衰弱，改善家庭收入并增加了照料者伯恩，对撒哈拉以南非洲的家庭粮食安全和家庭财富产生了毁灭性影响。受艾滋病毒和艾滋病影响的家庭中的五名儿童尤其高的风险 粮食不安全及其随后对营养和健康结果的负面影响。尽管普遍同意，即改善粮食安全和减少贫困​​的干预措施可能会改善对艾滋病毒流行的持续反应，但有关这种干预措施对艾滋病毒影响儿童的营养，健康和神经行为发展结果的有效性的证据死亡。这种干预措施在肯尼亚西部的Nyanza地区等环境中最需要：一个大型农村，农业地区，其特征是高水平的贫困，艾滋病毒，粮食不安全和儿童死亡率。在这里，我们建议利用最近资助的集群随机对照试验（NIMH R01MH107330）的基础设施，旨在确定肯尼亚西部的HIV受感染成人的HIV临床和其他健康状况（``父母研究''）的多源农业干预对改善HIV临床和其他健康状况的有效性。我们建议评估干预对受艾滋病毒感染儿童的营养，健康和神经行为发展结果的影响。父母的研究将包括8对匹配的医疗机构，与干预和控制臂的比例以1：1的比例随机分配，每个设施招募了44名HIV感染的成年参与者（n = 704名成年人，50％的女性），并随后持续2年。拟议的研究将参加并跟随所有受艾滋病毒影响的儿童（6至36个月的招募）及其初级护理人员（年龄> 18岁），他们居住在父母研究的参与者中（1：1的比例，干预和对照）。研究将 与他们的主要护理人员一起至少包括352名儿童（n = 176个研究臂）。将确定儿童的艾滋病毒状况，并将定期评估两年的儿童。我们的具体目的如下：目标1：确定干预对5岁以下艾滋病毒影响儿童的营养，健康和神经发育结果的影响。目的2：了解干预措施可以改善受艾滋病毒影响儿童的营养，健康和神经行为发展结果的途径。目标3：评估干预措施在儿童健康成果方面的增量成本和成本效益（与父母研究的成人分析协调）。通过解决粮食不安全和贫困的根本原因，干预措施可能有助于改善儿童营养，健康和神经行为发展。我们的项目对总统艾滋病救济紧急计划的几个优先领域以及有关受艾滋病毒和艾滋病影响的儿童的护理和治疗的几个优先领域。拟议的研究的结果将提供所需的证据，以促进综合的，多部门方法的扩展，如果证明是有效的，则可以促进综合的多个部门方法。