title: Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi.
abstract: The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). We conducted participant interviews at baseline, 18-, and 36-months on HIV vulnerability and related health outcomes, food security, and economic vulnerability. Randomly selected households (n = 1002) were interviewed in the intervention and control areas at baseline and 36 months. Compared to the control group, the intervention led to increased HIV testing (OR 1.90; 95 % CI 1.29-2.78) and HIV case finding (OR = 2.13; 95 % CI 1.07-4.22); decreased food insecurity (OR = 0.74; 95 % CI 0.63-0.87), increased nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants' outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.
authors.affiliation: Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA. weinhard@uwm.edu.
authors.forename: Lance S
authors.initials: LS
authors.lastname: Weinhardt
authors.affiliation: Center for Global Health Equity, College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201-0413, USA.
authors.forename: Loren W
authors.initials: LW
authors.lastname: Galvao
authors.affiliation: Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA. yanf@uwm.edu.
authors.forename: Alice F
authors.initials: AF
authors.lastname: Yan
authors.affiliation: College of Nursing, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201-0413, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Stevens
authors.affiliation: CARE-International Malawi, CARE House, Kenyatta Road, Capital City, Lilongwe, Malawi.
authors.forename: Thokozani Ng'ombe
authors.initials: TN
authors.lastname: Mwenyekonde
authors.affiliation: Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ngui
authors.affiliation: Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Emer
authors.affiliation: Joseph J Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA.
authors.forename: Katarina M
authors.initials: KM
authors.lastname: Grande
authors.affiliation: Department of Economics, Chancellor College, University of Malawi, P.O. Box 280, Zomba, Malawi.
authors.forename: Lucy
authors.initials: L
authors.lastname: Mkandawire-Valhmu
authors.affiliation: Professor Emeritus of Sociology, University of Pennsylvania and Visiting Scholar, California Center for Population Research, University of California-Los Angeles, 4284 Public Affairs Bldg, PO Box 957236, Los Angeles, CA, 90095-7236, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Watkins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000383:Agriculture / Q000191:economics; D003906:Developing Countries; D004467:Economics; D005260:Female; D005523:Food Supply / Q000191:economics*; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control* / Q000635:transmission; D006284:Health Plan Implementation / Q000191:economics / Q000458:organization & administration; D000073599:Health Risk Behaviors; D006801:Humans; D008295:Malawi; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D065228:Non-Randomized Controlled Trials as Topic; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment; D012424:Rural Population; D055815:Young Adult
keywords: Farmer field schools; Food security; HIV; Malawi; Microfinance; Quasi-experiment; Structural intervention; Sustainable agriculture