HIV and AIDS has had a devastating effect on family food security and household wealth in sub-Saharan Africa through the debilitation of the most productive household members, decreased household income, and increased caregiver burden. Children under five living in households affected by HIV and AIDS are at particularly high risk for food insecurity and its subsequent negative impacts on nutrition and health outcomes. While there is widespread agreement that interventions to improve food security and reduce poverty may improve ongoing responses to the HIV epidemic, there is a dearth of evidence regarding the effectiveness of such interventions on the nutritional, health and neurobehavioral development outcomes of HIV-affected children. Such interventions are most needed in settings such as Nyanza Region in Western Kenya: a largely rural, agricultural area characterized by high levels of poverty, HIV, food insecurity, and child mortality. Here, we propose to leverage the infrastructure of a recently funded cluster randomized controlled trial (NIMH R01MH107330) designed to determine the effectiveness of a multisectoral agricultural intervention on improving HIV clinical and other health outcomes of HIV-infected adults in Western Kenya (the `parent study'). We propose to assess the impact of the intervention on nutrition, health, and neurobehavioral development outcomes for HIV-affected children. The parent study will include 8 matched pairs of health facilities, randomized in a 1:1 ratio to the intervention and control arms, enrolling 44 HIV-infected adult participants per facility (N=704 adults, 50% female) and followed for 2 years. The proposed study will enroll and follow all HIV- affected children (enrolled at age 6- to- 36 months) and their primary caregiver (age >18 years) who reside in compounds of participants in the parent study (1:1 ratio, intervention and control). The study will include a minimum of 352 children (n=176 per study arm) with their primary caregiver. Children's HIV status will be ascertained, and children will be assessed at regular intervals for two years for the outcomes of interest.
Our specific aims are as follows:
Aim 1 : To determine the effect of the intervention on nutritional, health, and neurodevelopment outcomes of HIV-affected children under 5 years old.
Aim 2 : To understand the pathways through which the intervention may improve nutritional, health, and neurobehavioral development outcomes of HIV-affected children.
Aim 3 : To evaluate the incremental cost and cost-effectiveness of the intervention with respect to children's health outcomes (in coordination with the parent study's analysis for adults). By addressing the root causes of food insecurity and poverty, the intervention may contribute to improvements in child nutrition, health and neurobehavioral development. Our project is responsive to several priority areas of the President's Emergency Plan for AIDS Relief as well as those of the World Health Organization regarding care and treatment for children affected by HIV and AIDS. Results from the proposed study will provide the needed evidence to promote scale-up of an integrated, multisectoral approach, if it is shown to be effective.
Food insecurity and undernutrition are highly prevalent in sub-Saharan Africa, and are important determinants of poor health outcomes among HIV-affected children. This cluster randomized controlled trial will examine the impact of a multisectoral agricultural intervention on somatic growth, health, and neurobehavioral development outcomes of HIV-affected children age 6- to 59-months old in Nyanza Region, Western Kenya. The project has the potential to demonstrate the role of sustainable agricultural and economic interventions in improving the health and developmental trajectories of HIV-affected children in resource limited settings in sub-Saharan Africa.