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Comparative Study
. 2017 Mar;21(3):712-723.
doi: 10.1007/s10461-016-1455-1.

Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi

Lance S Weinhardt  1 , Loren W Galvao  2 , Alice F Yan  3 , Patricia Stevens  4 , Thokozani Ng'ombe Mwenyekonde  5 , Emmanuel Ngui  6 , Lindsay Emer  6 , Katarina M Grande  6 , Lucy Mkandawire-Valhmu  7 , Susan C Watkins  8
Affiliations
Comparative Study

Mixed-Method Quasi-Experimental Study of Outcomes of a Large-Scale Multilevel Economic and Food Security Intervention on HIV Vulnerability in Rural Malawi

Lance S Weinhardt et al. AIDS Behav. 2017 Mar.

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.

Keywords: Farmer field schools; Food security; HIV; Malawi; Microfinance; Quasi-experiment; Structural intervention; Sustainable agriculture.

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Conflict of interest statement

Compliance with Ethical StandardsConflict of InterestAll authors declare that they have no conflict of interest.Ethical ApprovalAll procedures performed in studies involving human participants were in accordance with the ethical standards of the U.S. institutional and Malawian national research committee and with the 1964 Helsinki declaration and its later amendments.Informed ConsentInformed consent was obtained from all individual participants included in the study.

References

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