title: Shamba Maisha: randomized controlled trial of an agricultural and finance intervention to improve HIV health outcomes.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  This is a 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 1 year. Data were collected on nutritional parameters, CD4 T-lymphocyte counts, and HIV RNA. Differences in 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/μl, P < 0.001) and proportion virologically suppressed in the intervention arm compared with the control arm (comparative improvement in proportion of 0.33 suppressed, odds ratio 7.6, 95% confidence interval: 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.
  
  
  CONCLUSIONS
  Livelihood interventions may be a promising approach to tackle the intersecting problems of food insecurity, poverty and HIV/AIDS morbidity.
authors.affiliation: aCenter of Expertise in Women's Health & Empowerment, University of California Global Health Institute bDivision of HIV/AIDS and Center for AIDS Prevention Studies, Departments of Medicine, University of California San Francisco (UCSF) cCentre for Microbiology Research, Kenya Medical Research Institute (KEMRI) dDepartment of Obstetrics, Gynecology & Reproductive Sciences, UCSF eDepartment of Health Promotion, Education and Behavior, University of South Carolina, South Carolina fSocial and Behavioral Sciences gEpidemiology and Biostatistics, UCSF hDepartment of Soil Science and Soil Microbial Biology, University of California Davis iDepartment of Medicine, Division of General Pediatrics, Boston Children's Hospital jDepartment of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Sheri D
authors.initials: SD
authors.lastname: Weiser
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Steinfeld
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
authors.forename: Elly
authors.initials: E
authors.lastname: Weke
authors.forename: Shari L
authors.initials: SL
authors.lastname: Dworkin
authors.forename: Kyle
authors.initials: K
authors.lastname: Pusateri
authors.forename: Stephen
authors.initials: S
authors.lastname: Shiboski
authors.forename: Kate
authors.initials: K
authors.lastname: Scow
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000383:Agriculture / Q000191:economics* / Q000458:organization & administration*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
chemical_list: D012367:RNA, Viral