Perceived impacts of a pilot agricultural livelihood and microfinance intervention on agricultural practices, food security and nutrition for Kenyans living with HIV

Introduction Agriculture is the primary source of income and household food for >75% of rural Kenyans, including people living with HIV (PLHIV), making agricultural yields an important factor in food security and nutrition. Previous studies have shown the interconnectedness of food insecurity, malnutrition, and poor HIV health by elucidating that having one of these conditions increases the likelihood and severity of having another. However, few studies have explored the linkages between agricultural practices, food security and nutrition for PLHIV, or how agricultural livelihood interventions may affect these domains. This study aimed to examine the mechanisms through which an agricultural livelihood intervention can positively or negatively affect agricultural practices, food security, and nutrition for PLHIV. Methods From July 2012-August 2013, we interviewed participants with HIV on antiretroviral therapy (ART) enrolled in a pilot randomized controlled trial (RCT) of an agricultural livelihood and finance intervention to understand the mechanisms through which the intervention may have affected HIV health outcomes. The intervention included agricultural and finance training and a microfinance loan to purchase the MoneyMaker hip pump, a human-powered water pump, seeds, and other farming implements. A purposive sample of 45 intervention and a random subset of 9 control participants were interviewed at 12-month endline visit with a subset of 31 intervention participants interviewed longitudinally at both the 3- and 12-month visits. Transcripts were double coded using an inductive-deductive approach and analyzed for impacts of the intervention on agricultural practices, food security, and nutrition using analytic reports for each key theme. Results All intervention participants described improvements in agricultural practices and yields attributed to the intervention while many also described improvements in income; these changes in turn contributed to improved HIV health, including suppressed viral loads, and a few people noted improved immunologic parameters. Key mechanisms included the knowledge gained from agricultural training which led to improved yields and access to new markets. The use of the irrigation pump was also identified as an additional, lesser important mechanism. All intervention participants reported sustained improvements in food security and nutrition through increased yields and income from the sale of excess crops used to purchase food, and diversification of fresh fruits and vegetables consumed through agricultural production. This led to self-reported weight gain which was a nutritional mechanism towards improved health. Conclusions Agricultural and finance interventions that improve farming practices could lead to improved health outcomes through the pathways of improved food security, income, and diversified diet. The results from this study helped the team to enhance the intervention prior to implementation of the larger cluster RCT (cRCT). By understanding how agricultural livelihood interventions act upon pathways towards improved health, policy options can be developed and implemented to include components that are needed to achieve sustainable outcomes. Trial registration ClinicalTrials.gov NCT01548599.

[1]  Amy A. Conroy,et al.  Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans: Longitudinal, qualitative findings , 2020, Transcultural psychiatry.

[2]  E. Frongillo,et al.  Agricultural and Finance Intervention Increased Dietary Intake and Weight of Children Living in HIV-Affected Households in Western Kenya , 2020, Current developments in nutrition.

[3]  Mardge H. Cohen,et al.  Food Insecurity, Internalized Stigma, and Depressive Symptoms Among Women Living with HIV in the United States , 2018, AIDS and Behavior.

[4]  P. Webb,et al.  Does ownership of improved dairy cow breeds improve child nutrition? A pathway analysis for Uganda , 2017, PloS one.

[5]  C. Cohen,et al.  A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya , 2016, Archives of Sexual Behavior.

[6]  E. Sadoulet,et al.  Estimating the Relative Benefits of Agricultural Growth on the Distribution of Expenditures , 2017, World Development.

[7]  C. Cohen,et al.  Changes in Health and Antiretroviral Adherence Among HIV-Infected Adults in Kenya: Qualitative Longitudinal Findings from a Livelihood Intervention , 2017, AIDS and Behavior.

[8]  E. Frongillo,et al.  How food insecurity contributes to poor HIV health outcomes: Qualitative evidence from the San Francisco Bay Area. , 2016, Social science & medicine.

[9]  S. Shiboski,et al.  Shamba Maisha: randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes , 2015, AIDS.

[10]  S. McCoy,et al.  Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review , 2015, AIDS and Behavior.

[11]  P. Amuna,et al.  Food supplementation among HIV-infected adults in Sub-Saharan Africa: impact on treatment adherence and weight gain , 2015, Proceedings of the Nutrition Society.

[12]  S. Shiboski,et al.  Archived Version from Ncdocks Institutional Repository 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 Shamba Maisha: Pilot Agricultural Intervention , 2022 .

[13]  X. Diao,et al.  Toward an Understanding of Economic Growth in Africa: A Reinterpretation of the Lewis Model , 2017, World Development.

[14]  James Thurlow,et al.  Beyond Agriculture versus Nonagriculture: Decomposing Sectoral Growth–Poverty Linkages in Five African Countries , 2014, World Development.

[15]  S. McCoy,et al.  A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS , 2014, AIDS and Behavior.

[16]  H. Leslie,et al.  Descriptive Characteristics and Health Outcomes of the Food by Prescription Nutrition Supplementation Program for Adults Living with HIV in Nyanza Province, Kenya , 2014, PloS one.

[17]  Jeffrey N. Martin,et al.  Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda , 2014, AIDS.

[18]  S. Sachs,et al.  HIV affected households in Western Kenya experience greater food insecurity , 2013 .

[19]  M. Gibson Food Security—A Commentary: What Is It and Why Is It So Complicated? , 2012, Foods.

[20]  S. Young,et al.  Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria, Kenya , 2012, AIDS care.

[21]  Elizabeth W. Kamau-Mbuthia,et al.  Food insecurity is associated with attitudes towards exclusive breastfeeding among women in urban Kenya. , 2012, Maternal & child nutrition.

[22]  P. Tien,et al.  Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS. , 2011, The American journal of clinical nutrition.

[23]  Luc Christiaensen,et al.  The (Evolving) Role of Agriculture in Poverty Reduction: An Empirical Perspective , 2011 .

[24]  O. Oladele Features of agricultural extension models and policy in selected sub - Saharan Africa countries , 2011 .

[25]  A. V. D. Ban Global Review of Good Agricultural Extension and Advisory Practices , 2010 .

[26]  A. Martin-Hilber,et al.  Patient‐reported barriers and drivers of adherence to antiretrovirals in sub‐Saharan Africa: a meta‐ethnography , 2010, Tropical medicine & international health : TM & IH.

[27]  D. Bangsberg,et al.  Food Insecurity as a Barrier to Sustained Antiretroviral Therapy Adherence in Uganda , 2010, PloS one.

[28]  D. Spielman,et al.  Millions Fed: Proven Successes in Agricultural Development , 2009 .

[29]  Kimberly A. Fernandes,et al.  The Association Between Food Insecurity and Mortality Among HIV-Infected Individuals on HAART , 2009, Journal of acquired immune deficiency syndromes.

[30]  A. Beyene,et al.  African Agriculture and The World Bank: Development or Impoverishment? , 2008 .

[31]  P. Hebinck,et al.  Understanding rural poverty and investment in agriculture: an assessment of integreated quantitative and qualitative research in Western Kenya , 2007 .

[32]  W. B. Morgan,et al.  Agricultural crisis in Sub-Saharan Africa: Development constraints and Policy Problems , 1994 .

[33]  A. Huberman,et al.  Qualitative Data Analysis: A Methods Sourcebook , 1994 .

[34]  D. Bangsberg,et al.  Food insecurity and HIV clinical outcomes in a longitudinal study of homeless and marginally housed HIV-infected individuals in San Francisco , 2013 .

[35]  R. Hogg,et al.  Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco , 2008, Journal of General Internal Medicine.