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, Loren W. Galvao, Alice F. Yan, Patricia Stevens, Thokozani Ng’ombe Mwenyekonde, Emmanuel Ngui, Lindsay Emer, Katarina M. Grande, Lucy Mkandawire-Valhmu, Susan C. Watkins

Research output: Contribution to journalArticlepeer-review

19 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)712-723
Number of pages12
JournalAIDS and Behavior
Volume21
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Bibliographical note

Funding Information:
This study was funded by the National Institutes of Health, Eunice K. Shriver National Institute of Child Health and Human Development grant R01-HD055868 (2008–2015).

Publisher Copyright:
© 2016, The Author(s).

Keywords

  • Farmer field schools
  • Food security
  • HIV
  • Malawi
  • Microfinance
  • Quasi-experiment
  • Structural intervention
  • Sustainable agriculture

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