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Food Security Research

The Impact of Food Security on HIV Outcomes and Sexual Risk Behavior in Uganda

Contact person: Sheri Weiser, MD; sheri.weiser@ucsf.edu

This NIH-funded study provides the first longitudinal assessment of impacts of food insecurity on HIV health outcomes in a resource-limited setting. The aims of the study are: (1) To determine the impact of food insecurity on antiretroviral (ART) adherence among HIV-infected individuals in the Uganda Antiretroviral Treatment Outcomes (UARTO) cohort in Mbarara, Uganda; (2) To determine the impact of food insecurity on HIV health outcomes in the UARTO cohort; and (3) To determine the impact of food insecurity on high-risk sexual behaviors in the UARTO cohort and how gender modifies these relationships. This information will be critical in order to develop interventions to address food insecurity among people living with HIV and AIDS.

Supplemental funding for this study from the Hellman Family Foundation and the Burke Global Health Scholars Award enabled investigators to understand the role of gender and sexual relationship power in mediating negative impacts of food insecurity on HIV health outcomes and risky sexual behaviors.

Shamba Maisha: Pilot agricultural intervention for food security and HIV health outcomes in Kenya

Contact Persons: Sheri Weiser, MD: sheri.weiser@ucsf.edu
Craig Cohen, MD: CCohen@globalhealth.ucsf.edu

Project Goals

This NIH-funded project provides a novel approach to addressing the intersecting epidemics of food insecurity and HIV/AIDS by evaluating the impacts of a pilot multi-sectoral agricultural intervention on health and socioeconomic outcomes among people living with HIV/AIDS in Western Kenya. The study has the following aims: 1) To operationalize and pilot test key design elements of a future cluster randomized control trial (RCT) aimed to improve health outcomes among HIV-infected patients in Western Kenya. The intervention includes: a) a human-powered water pump and other required farm commodities, b) a microfinance loan (~$75) to purchase the pump and agricultural implements, and c) training in financial management and sustainable farming practices. 2) To conduct a pilot study of the agricultural intervention on 140 HIV-infected farmers to determine the preliminary impact of the intervention on mediating outcomes (food security, and household economic indicators), and on primary health outcomes of interest for the planned RCT (HIV treatment outcomes, HIV transmission risk and women’s empowerment). 3) To assess the acceptability and feasibility of intervention and control conditions, and systematically translate lessons learned in the pilot study into the design of a cluster RCT. Our hypothesis is that this intervention will improve food security and income, thereby enhancing HIV treatment adherence, reducing treatment failure, decreasing co-morbidities, improving gender empowerment, and reducing secondary HIV transmission.

Supplemental funding from UCGHI and from the World food Programme enables investigators to conduct an in-depth qualitative study and process evaluation to understand impacts of the intervention from the perspective of participants.

Publications
  1. Weiser SD, Tuller DM, Frongillo EA, Senkungu J, Mukiibi N, Bangsberg DR. Food insecurity as a barrier to sustained antiretroviral therapy in Uganda. PLoS One. April 2010: 5(4):e10340.
  2. Weiser SD, Tsai AC, Gupta R, Frongillo EA, Kawuma A, Senkugu J, Hunt PW, Emenyonu NI, Mattson JE, Martin JN, Bangsberg DR. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in rural Uganda. AIDS. January 2012:26(1):67-75.
  3. Weiser SD, Gupta R, Tsai AC, Frongillo EA, Grede N, Kumbakumba E, Kawuma A, Hunt PW, Martin JN, Bangsberg DR. Changes in food insecurity, nutritional status and physical health status after antiretroviral therapy initiation in rural Uganda. In Press, JAIDS, June 2012. [Epub Ahead of Print].