Adolescent Behavior Clinical Trial
Official title:
Shamba Maisha: Assessing the Preliminary Effects of a Multisectoral Agricultural Intervention on the Sexual and Reproductive Health of HIV-affected Adolescent Girls in Western Kenya
The goal of this study is to understand how the Shamba Maisha household agricultural and economic intervention impacts the sexual, reproductive, and nutritional health of adolescent girls. The intervention includes: a) a human-powered water pump and other required farm commodities, b) a micro-finance loan (~$75) to purchase the pump and agricultural implements, and c) education in sustainable farming practices.
Food insecurity (FI) and poverty are important drivers of HIV vulnerability among adolescent
girls, and contribute to worse sexual and reproductive health (SRH) outcomes. While most
approaches to improving adolescent SRH outcomes have focused on individual-centered
approaches alone, integrated family-level interventions that address the underlying context
for risk behaviors such as poverty and FI may be more effective in reducing adverse SRH
outcomes. A household-level multisectoral agricultural and finance intervention in Nyanza
Region, Kenya called Shamba Maisha (SM) designed to mitigate household FI and improve health
in HIV-affected households has been successfully developed and piloted. In mid-2016, a large
cluster-randomized controlled trial (RCT) of SM was launched, targeting 704 adults and 352
young children to test the effectiveness of this intervention. This pilot study leverages the
SM RCT infrastructure to recruit up to 240 adolescent girls residing in SM households and
assess the impact of the SM intervention at the household level on adolescent girls' SRH
outcomes at study endline. The central hypothesis is that improvements in household FI and
wealth will contribute to reduced sexually transmitted infections (STIs), HIV, and unintended
pregnancies among adolescent girls. To test this hypothesis, demographic, behavioral,
clinical, and biological data from adolescent girls and their caregivers living in
intervention and control SM households will be collected. The primary outcomes are food
security, depressive symptoms, and sexual risk behaviors in the adolescent girls. The
secondary outcomes are pregnancy/unintended pregnancy, HIV, herpes simplex virus 2 (HSV-2),
and nutritional status in the adolescent girl.
The ultimate goal is to develop an intervention tailored specifically to the needs of
adolescent girls to help reverse the cycle of FI, poverty, low empowerment, and poor SRH
outcomes among adolescent girls. If proven efficacious, the proposed intervention may: 1)
halt or slow down the cycle of incident HIV, other STIs, and unintended pregnancies to
improve the lives of adolescent girls in similar settings, and 2) help achieve several top
Sustainable Development Goals (SDG) including SDG 1 (zero poverty), SDG 2 (zero hunger), SDG
3 (good health and wellbeing), and SDG 5 (gender equality).
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