Innovative strategies are needed to improve progress towards the UNAIDS 90-90-90 targets in West Africa1. Among the 5 million people living with HIV (PLHIV) in West and Central Africa in 2018, 64% knew their HIV status, 51% were receiving antiretroviral therapy (ART), and 39% had suppressed viral loads2. Although 13% of PLHIV globally live in West and Central Africa, 21% of AIDS-related deaths in 2018 occurred in the region. Addressing weaknesses along the entire continuum of care, including barriers to sustained ART and viral suppression, is critical to interrupting transmission, preventing mortality, and ending the HIV epidemic. Our previous work has shown that the majority of PLHIV in Senegal are food insecure and that food insecurity is associated with poor HIV outcomes. Food insecurity can contribute to increased risk of HIV acquisition through high-risk behaviors and coping strategies. Food insecurity is a barrier to retention in care. In our K23 longitudinal study conducted among HIV-positive individuals initiating ART in Senegal, food insecurity was an independent predictor of loss to follow-up. Food insecurity is also associated with poor adherence to ART, which increases risk of virologic failure, HIV transmission, drug resistance, and death. The high prevalence of food insecurity among PLHIV in Senegal and its role as a driver of poor outcomes across the HIV care cascade, suggest that strategies to address food insecurity will be critical to achieving the 90-90-90 targets and ending the HIV epidemic. The Casamance, located in the south of Senegal, has been the most severely affected by the HIV epidemic and has the highest prevalence of food insecurity in the country. In collaboration with Development in Gardening, the Service des Maladies Infectieuses et Tropical, Centre Hospitalier Universitaire de Fann, and the Centre de Sant de Ziguinchor, we recently received funding to implement a clinic and community based agriculture program targeting PLHIV in Ziguinchor, located in the Casamance. In the proposed study, we will build upon findings from our K23 study of HIV, malnutrition, and food insecurity, and leverage our recently funded agriculture program, to evaluate the impact of a multisectoral agriculture intervention on HIV outcomes in the Casamance region of Senegal.
The AIMS of this study are, AIM 1: Determine if participation in a multisectoral agriculture intervention is associated with improved HIV outcomes compared to the standard of care, AIM 2: Determine if participation in a multisectoral agriculture intervention is associated with improved food security and nutritional status among PLHIV compared to the standard of care, and AIM 3: Understand the impact of food insecurity on the behaviors and experiences of PLHIV and determine patient perceptions of a multisectoral agriculture intervention implemented in the Casamance region of Senegal.
The high prevalence of food insecurity among PLHIV in Senegal and its role as a driver of poor outcomes across the HIV care cascade, suggest that strategies to address food insecurity will be critical to achieving the 90-90-90 targets and ending the HIV epidemic. This study will be conducted in order to determine the impact of a multisectoral agriculture intervention on food insecurity and HIV outcomes in Senegal, West Africa.
