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（由申请人提供）：艾滋病毒和艾滋病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的影响，使最具生产力的家庭成员变得虚弱，家庭收入减少，照顾者的负担增加。生活在受艾滋病毒和艾滋病影响的家庭中的五岁以下儿童， 粮食不安全及其对营养和健康结果的负面影响。虽然人们普遍认为，改善粮食安全和减少贫穷的干预措施可能会改善目前对艾滋病毒流行病的应对措施，但缺乏证据表明这种干预措施对受艾滋病毒影响的儿童的营养、健康和神经行为发展结果的有效性。在肯尼亚西部的尼扬扎地区这样的环境中，最需要这种干预措施：这是一个以高度贫困、艾滋病毒、粮食不安全和儿童死亡率为特点的主要农村农业地区。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，旨在确定多部门农业干预措施对改善肯尼亚西部艾滋病毒感染成年人的艾滋病毒临床和其他健康结果的有效性（“家长研究”）。我们建议评估干预措施对受艾滋病毒影响儿童的营养、健康和神经行为发育结果的影响。母研究将包括8对匹配的卫生机构，以1：1的比例随机分配到干预组和对照组，每个机构招募44名HIV感染的成年受试者（N=704名成年人，50%为女性），并随访2年。拟议的研究将招募并随访所有受艾滋病毒影响的儿童（年龄在6至36个月时招募）及其主要照顾者（年龄>18岁），他们居住在母研究（1：1比例，干预和对照）参与者的化合物中。这项研究将 包括至少352名儿童（每个研究组n=176）及其主要照顾者。将确定儿童的艾滋病毒状况，并定期对儿童进行为期两年的评估，以了解有关结果。我们的具体目标如下：目标1：确定干预对5岁以下受艾滋病毒影响儿童的营养、健康和神经发育结果的影响。目标二：了解干预措施可能改善受艾滋病毒影响儿童的营养、健康和神经行为发育结果的途径。目标三：评估干预措施对儿童健康结果的增量成本和成本效益（与成人家长研究分析相协调）。通过解决粮食不安全和贫困的根源，干预措施可能有助于改善儿童营养、健康和神经行为发育。我们的项目响应了总统艾滋病紧急救援计划以及世界卫生组织关于受艾滋病毒和艾滋病影响儿童的护理和治疗的几个优先领域。拟议研究的结果将提供必要的证据，以促进扩大综合、多部门办法，如果这种办法被证明是有效的。