Shamba Maisha: A pilot study assessing impacts of a micro-irrigation intervention on the health and economic wellbeing of HIV patients

Pandit, Jay A; Sirotin, Nicole; Tittle, Robin; Onjolo, Elijah; Bukusi, Elizabeth A.; Cohen, Craig R.

doi:10.1186/1471-2458-10-245

Cited by 25 publications

(25 citation statements)

References 14 publications

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“…Future research could further clarify the mechanisms by which adolescents are more likely to enroll with low BMI. Furthermore, interventions to directly improve the nutritional status of underweight persons (Mamlin et al, 2009) and structural interventions that improve food access, such as agricultural production projects (Pandit et al, 2010), may be imperative to the overall success of HIV/AIDS and nutrition support programs.…”

Section: Resultsmentioning

confidence: 99%

Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province, Kenya

et al. 2013

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Low BMI at time of enrollment into HIV care has been shown to be a strong predictor of mortality independent of CD4 count. This study investigated socio-demographic associations with underweight (BMI<18.5) among adults in Nyanza Province, Kenya upon enrollment into HIV care. BMI, socio-demographic, and health data from a cross-sectional sample of 8,254 women and 3,533 men were gathered upon enrollment in the Family AIDS Care and Education Services (FACES) program in Nyanza Province, Kenya between January 2005 and March 2010. Overall, 27.4% of adults were underweight upon enrollment in HIV care. Among both women [W] and men [M], being underweight was associated with younger age (W: adjusted odds ratio [AOR] 2.90; 95% confidence interval [CI] 1.85-4.55; M: AOR, 5.87; 95% CI, 2.80-12.32 for age 15-19 compared to ≥50 years old), less education (W: AOR 2.92; 95% CI, 1.83-4.65; M: AOR, 1.55; 95% CI, 1.04-2.31 for primary education compared to some college/university), low CD4 count (W: AOR 2.13; 95% CI, 1.50-3.03; M: AOR, 1.43; 95% CI, 0.76-2.70 for 0-250 compared to ≥750 cells/mm3), and poor self-reported health status (W: AOR 1.72; 95% CI, 0.89-3.33; M: AOR, 9.78; 95% CI, 1.26-75.73 for poor compared to excellent). Male gender, lower educational attainment, younger age, and poor self-reported health are associated with low BMI at enrollment into HIV care in Nyanza Province. HIV care and treatment programs should consider using socio-demographic and health risk factors associated with low BMI to target and recruit patients with the goal of preventing late enrollment into care.

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Section: Resultsmentioning

confidence: 99%

Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province, Kenya

et al. 2013

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“…As an example of this approach, a small study in rural Kenya showed that an intervention that used a microirrigation water pump combined with a microfinance loan led to increases in crop yields, household income, BMI, and CD4 counts (189). More research is needed on structural interventions to address the root causes of poverty and food insecurity, to improve HIV health outcomes, and decrease HIV transmission risk (26,49,90,182).…”

Section: Need For Intervention Studiesmentioning

confidence: 97%

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Weiser

Young

Cohen

et al. 2011

The American Journal of Clinical Nutrition

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378

427

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Food insecurity, which affects >1 billion people worldwide, is inextricably linked to the HIV epidemic. We present a conceptual framework of the multiple pathways through which food insecurity and HIV/AIDS may be linked at the community, household, and individual levels. Whereas the mechanisms through which HIV/AIDS can cause food insecurity have been fairly well elucidated, the ways in which food insecurity can lead to HIV are less well understood. We argue that there are nutritional, mental health, and behavioral pathways through which food insecurity leads to HIV acquisition and disease progression. Specifically, food insecurity can lead to macronutrient and micronutrient deficiencies, which can affect both vertical and horizontal transmission of HIV, and can also contribute to immunologic decline and increased morbidity and mortality among those already infected. Food insecurity can have mental health consequences, such as depression and increased drug abuse, which, in turn, contribute to HIV transmission risk and incomplete HIV viral load suppression, increased probability of AIDS-defining illness, and AIDS-related mortality among HIV-infected individuals. As a result of the inability to procure food in socially or personally acceptable ways, food insecurity also contributes to risky sexual practices and enhanced HIV transmission, as well as to antiretroviral therapy nonadherence, treatment interruptions, and missed clinic visits, which are strong determinants of worse HIV health outcomes. More research on the relative importance of each of these pathways is warranted because effective interventions to reduce food insecurity and HIV depend on a rigorous understanding of these multifaceted relationships.

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“…International experts call for sustainable approaches addressing drivers and consequences of food insecurity such as agricultural and other livelihood approaches. In this study, we conducted a pilot cluster RCT to assess the effects of a multisectoral agricultural and finance intervention we initially developed and evaluated in a small feasibility study [19], on health outcomes among people living with HIV/AIDS [PLHIV] in rural Kenya.…”

Section: Introductionmentioning

confidence: 99%

Shamba Maisha

Weiser

Bukusi

Steinfeld³

et al. 2015

Aids

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Objectives Food insecurity and HIV/AIDS outcomes are inextricably linked in sub-Saharan Africa. We report on health and nutritional outcomes of a multisectoral agricultural intervention trial among HIV-infected adults in rural Kenya. Design Pilot cluster randomized controlled trial Methods The intervention included a human-powered water pump, a microfinance loan to purchase farm commodities, and education in sustainable farming practices and financial management. Two health facilities in Nyanza Region, Kenya were randomly assigned as intervention or control. HIV-infected adults 18 to 49 years old who were on antiretroviral therapy and had access to surface water and land were enrolled beginning in April 2012 and followed quarterly for one year. Data were collected on nutritional parameters, CD4 T lymphocyte counts, and HIV RNA. Difference in difference fixed-effects regression models were used to test whether patterns in health outcomes differed over time from baseline between the intervention and control arms. Results We enrolled 72 and 68 participants in the intervention and control groups, respectively. At 12 months follow-up, we found a statistically significant increase in CD4 cell counts (165 cells/mm3, p<0.001) and proportion virologically suppressed in the intervention arm compared to the control arm (comparative improvement in proportion of 0.33 suppressed, OR 7.6, 95% CI: 2.2–26.8). Intervention participants experienced significant improvements in food security (3.6 scale points higher, p<0.001) and frequency of food consumption (9.4 times per week greater frequency, p=0.013) compared to controls. Conclusion Livelihood interventions may be a promising approach to tackle the intersecting problems of food insecurity, poverty and HIV/AIDS morbidity.

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Shamba Maisha: A pilot study assessing impacts of a micro-irrigation intervention on the health and economic wellbeing of HIV patients

Cited by 25 publications

References 14 publications

Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province, Kenya

Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province, Kenya

Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS

Shamba Maisha

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