Effect of a climate-smart intervention on agriculture and nutrition of people with HIV

To evaluate impacts of Shamba Maisha , a climate-smart agriculture intervention, on agricultural and nutrition outcomes of people with HIV.

Secondary analysis of a parallel, nonblinded cluster-randomized controlled trial.

Western Kenya.

Clusters were clinics providing HIV services to more than 350 patients. Participants were adults aged 18-60 years in a patient support group, receiving antiretroviral therapy for at least 6 months, with access to land and water source, and moderate-to-severe food insecurity and/or BMI less than 18.5 kg/m 2 .

A market-rate loan (175 USD) for irrigation pump and agricultural inputs, and a series of training sessions on climate-smart agriculture and financial management. Trial registration: NCT02815579.

Primary outcomes: dietary diversity (count of food groups/day) and crop diversity (count of crops/year). Secondary outcomes: low mid-upper arm circumference (MUAC <24.5 cm), value of agricultural production (1000 KSH/year), farmland use (hectares). Outcomes were assessed at 0, 6, 12, 18, and 24 months. Analyses were by intention-to-treat.

Between June 2016 and December 2017, 16 clinics were randomly allocated to intervention or control (1 : 1 ratio). Seven hundred and twenty participants were enrolled (366 intervention; 354 control), and 677 participants evaluated (344 intervention; 333 control). Relative to control, the intervention increased crop diversity {mean difference-in-difference: 1.9 [95% confidence interval (CI) 1.52, 2.32]} and value of agriculture production [3.9 (0.05, 7.73)], and reduced farmland use [-0.9 (-1.34, -0.42)]. There was no effect on diet diversity [-0.2 (-0.37, 0.03)] or MUAC (OR 0.76 [0.39, 1.45]).

Climate-smart agriculture interventions can improve agricultural outcomes but may benefit from additional nutrition-sensitivity to improve nutrition.