Assessing the Preliminary Effects of a Multisectoral Agricultural Intervention on Adolescent Girls' Health

University of California San Francisco (UCSF)

Status: Completed

Conditions: Sexual Behavior; Adolescent Behavior; Reproductive Behavior

Treatments: Other: Multi-sectoral agricultural intervention

Study type: Interventional

Funder types: Other

Identifiers

NCT03741634

1R21HD095739

Details and patient eligibility

About

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.

Full description

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).

Enrollment: 241 patients

Sex: Female

Ages: 13 to 20 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• an adult participating in the parent study
• a currently unmarried adolescent girl aged 13-20 years old (preferred target of 15-19)
• the adolescent girl has a parent/primary guardian age >18 years old who resides in the household

Exclusion criteria

• adolescent girls with a confirmed HIV diagnosis by clinical records prior to the start of SM
• married adolescent girls
• those who do not speak Dholuo, Swahili, or English
• those who are heads of households
• those ages 18 to 20 who are enrolled in the parent study
• those with inadequate cognitive and/or hearing capacity.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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241 participants in 2 patient groups

Intervention

Experimental group

Description:

Participants enrolled at one study location will receive the Multi-sectoral agricultural intervention as specified below under the intervention.

Treatment:

Other: Multi-sectoral agricultural intervention

No intervention

No Intervention group

Description:

During the study, participants enrolled at one study location will non receive the Multi-sectoral agricultural intervention. At the end of the study, participants in this arm will be eligible for education in financial management and sustainable farming practices and those who pay the loan down payment will be eligible for a small loan to purchase a human-powered water pump, seeds, fertilizers and, pesticides.