Shamba Maisha: Pilot agricultural intervention for food security and HIV health outcomes in Kenya: design, methods, baseline results and process evaluation of a cluster-randomized controlled trial

Abstract

BackgroundDespite advances in treatment of people living with HIV, morbidity and mortality remains unacceptably high in sub-Saharan Africa, largely due to parallel epidemics of poverty and food insecurity.Methods/DesignWe conducted a pilot cluster randomized controlled trial (RCT) of a multisectoral agricultural and microfinance intervention (entitled Shamba Maisha) designed to improve food security, household wealth, HIV clinical outcomes and women’s empowerment. The intervention was carried out at two HIV clinics in Kenya, one randomized to the intervention arm and one to the control arm. HIV-infected patients >18 years, on antiretroviral therapy, with moderate/severe food insecurity and/or body mass index (BMI) <18.5, and access to land and surface water were eligible for enrollment. The intervention included: 1) a microfinance loan (~$150) to purchase the farming commodities, 2) a micro-irrigation pump, seeds, and fertilizer, and 3) trainings in sustainable agricultural practices and financial literacy. Enrollment of 140 participants took four months, and the screening-to-enrollment ratio was similar between arms. We followed participants for 12 months and conducted structured questionnaires. We also conducted a process evaluation with participants and stakeholders 3–5 months after study start and at study end.DiscussionBaseline results revealed that participants at the two sites were similar in age, gender and marital status. A greater proportion of participants at the intervention site had a low BMI in comparison to participants at the control site (18% vs. 7%, p = 0.054). While median CD4 count was similar between arms, a greater proportion of participants enrolled at the intervention arm had a detectable HIV viral load compared with control participants (49% vs. 28%, respectively, p < 0.010). Process evaluation findings suggested that Shamba Maisha had high acceptability in recruitment, delivered strong agricultural and financial training, and led to labor saving due to use of the water pump. Implementation challenges included participant concerns about repaying loans, agricultural challenges due to weather patterns, and a challenging partnership with the microfinance institution. We expect the results from this pilot study to provide useful data on the impacts of livelihood interventions and will help in the design of a definitive cluster RCT.Trial registrationThis trial is registered at ClinicalTrials.gov, NCT01548599.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-015-0886-x) contains supplementary material, which is available to authorized users.

Shamba Maisha

“…As described elsewhere, we selected two health facilities supported by Family AIDS Care & Education Services (FACES) and randomly selected one as intervention and the other as control [21]. Control participants were eligible for the intervention at the end of the one-year follow-up period.…”

“…The Shamba Maisha intervention has three components [21]: 1) Loan program : Microfinance loans were provided and managed by Adok Timo , a Kenyan microfinance organization, with support from UCSF and KEMRI. Intervention participants were required to save 500 Kenyan shillings (~$6.00 USD) prior to receiving the loan (~$150 USD), which was used to purchase farming implements and a MoneyMaker water pump.…”

A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya

“…The intervention trial was registered at ClinicalTrials.gov (NCT01548599) and has been fully described elsewhere (Cohen et al, 2015). Two government health facilities that met the requirements of the study were selected and randomly assigned to the intervention or control site.…”

“…Furthermore, poverty has been found to have a complex relationship with HIV and to play a multidimensional role that is shaped by the broader social environment (Kim, Pronyk, Barnett, & Watts, 2008). Thus, researchers have increasingly called for multisectoral intervention packages that go beyond one structural factor to incorporate several that are appropriate to the local context, such as food security and property rights (Dworkin & Blankenship, 2009; Cohen et al, 2015; Dworkin et al, 2013; Kim et al, 2007; Weinhardt et al, 2009, 2014). …”

Use of house cricket to address food security in Kenya: Nutrient and chitin composition of farmed crickets as influenced by age

“…High prevalence of malnutrition, characterised by stunting early in life has been demonstrated in the Kenyan population by studies done recently, and lack of proteins is rated high in Kenyan children (Kimani-Murage et al, 2015;M'Kaibi et al, 2015). There has also been increased cases in morbidity and mortality due to poverty and food insecurity (Cohen et al, 2015).…”