DESCRIPTION (provided by applicant): Despite major advances in care and treatment for those living with HIV, morbidity and mortality among people living with HIV/AIDS (PLHIV) remain unacceptably high in sub-Saharan Africa (SSA), largely due to the parallel challenges of poverty and food insecurity. Food insecurity and poverty contribute to higher morbidity and mortality among PLHIV, and there has been increasing international recognition of the need to address these factors for a successful global response to the HIV epidemic. Yet, to date there have been few studies to systematically evaluate the impact and cost-effectiveness of promising food security interventions on health outcomes among PLHIV. To address these gaps, together with KickStart, a non-governmental organization based in SSA, we have developed a multisectoral intervention in Nyanza Region, Kenya that includes: a) a microfinance loan (~$175) for purchasing agricultural implements and commodities; b) agricultural implements to be purchased with the loan including a human-powered water pump, seeds, fertilizers and pesticides; and c) education in financial management and sustainable farming practices. We successfully completed an NIH- funded pilot intervention trial that showed that the intervention was feasible, acceptable and may improve HIV- related health. We now plan to conduct a cluster randomized controlled trial (RCT) of this intervention with the following specific aims: Ai 1: To determine the impact of a multisectoral agricultural intervention among HIV- infected farmers on ART on HIV clinical outcomes. We hypothesize that the intervention will lead to improved viral load suppression (primary outcome) and decreased HIV-related morbidity in the intervention arm

PUBLIC HEALTH RELEVANCE: Food insecurity contributes to increased HIV transmission risk and higher HIV-related morbidity and mortality, yet few studies have systematically evaluated the impact of sustainable food security interventions on health, economic, and behavioral outcomes among people living with HIV/AIDS. To address this gap, our interdisciplinary team will conduct a randomized control trial in the Nyanza Region, Kenya to understand whether a multisectoral agricultural and finance intervention improves HIV clinical outcomes, and to elucidate the causal pathways (nutritional, mental health, and behavioral) through which the intervention may lead to these outcomes. If proven effective and cost-effective, scaling up this intervention will help to further several of the top Millennium Development Goals (MDGs), including MDG1 (eradicate extreme hunger and poverty), MDG3 (promote female empowerment), and MDG6 (combat HIV/AIDS).