- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03170986
Multi-Sectoral Agricultural Intervention to Improve Nutrition, Health, and Developmental Outcomes of HIV-infected and Affected Children in Western Kenya
Study Overview
Status
Intervention / Treatment
Detailed Description
HIV and AIDS has had a devastating effect on household food security and wealth in sub-Saharan Africa through the debilitation of the most productive household members, decreased household income, and increased caregiver burden. Children under five living in households affected by HIV and AIDS are at particularly high risk for food insecurity and its subsequent negative impacts on nutrition, health, and neurobehavioral development outcomes. While there is widespread agreement that interventions to reduce food insecurity and poverty may improve ongoing responses to the HIV epidemic, there is a dearth of evidence regarding the effectiveness of such interventions on the nutritional, health and neurobehavioral development outcomes of HIV-affected children. Such interventions are most needed in settings such as Nyanza Region in Western Kenya: a largely rural, agricultural area characterized by high levels of poverty, HIV, food insecurity, and child mortality.
The investigators have successfully completed a one-year pilot intervention study at two health facilities in Nyanza Region including 140 (n=72 intervention, n=68 control) HIV-infected adults on antiretroviral therapy which evaluated the potential effectiveness of an integrated, multisectoral agricultural and microfinance intervention called "Shamba Maisha" ("Farm Life"), designed to increase household food security and wealth in HIV-affected households. Shamba Maisha includes a) a microfinance loan (~$175) for purchasing agricultural implements and commodities; b) agricultural implements, purchased with the loan, including a human-powered water pump, seeds, fertilizers and pesticides; and c) education in financial management and sustainable farming practices occurring in the setting of patient support groups. The trial demonstrated the feasibility, acceptability, and short-term effectiveness of Shamba Maisha on improving household food security, diet quality and health outcomes of adults living with HIV. The investigators have also successfully completed a one-year companion pediatric study in which they tested preliminary impacts of Shamba Maisha on nutritional outcomes of HIV-affected children under 5 years old who resided in households of participants in the parent study (N=200 children and 126 primary caregivers). At baseline, the investigators observed a significant degree of undernutrition in both groups. They observed statistically significant gains in weight over time for children over six months old in the intervention group (group by time interaction, p=0.01) compared to the control group, but the sample size and follow-up time were insufficient to test effects on height. A larger sample size in a randomized design with longer follow-up period is needed for a definitive test of the effectiveness of this intervention on children's health outcomes.
The investigators now propose to leverage the infrastructure of the recently funded cluster randomized controlled trial, designed to determine the effectiveness of Shamba Maisha on HIV clinical and other health outcomes of HIV-infected adults in Western Kenya (the 'parent study'). They propose to assess the impact of the intervention on nutrition, health, and neurobehavioral development outcomes for HIV-affected children. The parent study will include 8 matched pairs of health facilities, randomized in a 1:1 ratio to the intervention and control arms, enrolling 44 HIV-infected adult participants per facility (N=704 adults, 50% female) and followed for 2 years. The proposed study will enroll and follow HIV-affected children (enrolled at age 6 to <36 months) and their primary caregiver (age >18 years) who reside in compound/homesteads of participants in the parent study (1:1 ratio, intervention and control). The study will include a minimum of 352 children (n=176 per study arm) with their primary caregiver. Specific aims are: Aim 1. To determine the effect of Shamba Maisha on nutritional, health, and neurobehavioral development outcomes of HIV-affected children under 5 years old. The investigators hypothesize that children living in intervention households will have greater somatic growth (weight-for-age, height-for-age, and weight-for-height z-scores)(primary outcome), reduced morbidity and hospitalizations, and improved neurobehavioral development outcomes (secondary outcomes) compared to children living in households that do not receive the intervention. The investigators will collect data on children's nutrition, health, and neurobehavioral development outcomes over a 2-year follow-up period. Aim 2. To understand the pathways through which Shamba Maisha may improve nutritional, health, and neurobehavioral development outcomes of HIV-affected children. The investigators hypothesize that improvements in household food security and household wealth will contribute to improved child outcomes through improvements in: child diet, caregiver physical and mental health, caregiver empowerment, and home environment pathways, and this study will provide important details about those pathways. Aim 3. To evaluate the incremental cost and cost-effectiveness of the intervention with respect to children's health outcomes (in coordination with the parent study's analysis for adults). The investigators will translate observed reduced morbidity to averted Disability Adjusted Life Years (DALYs), using disability weights from the Global Burden of Disease, estimate net costs considering the intervention and averted health care costs, and calculate incremental cost-effectiveness, as the net cost per DALY averted.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
-
Homa Bay, Kenya
- Kitare
-
Homa Bay, Kenya
- Sindo
-
Kisumu, Kenya
- Hongo Ogosa
-
Kisumu, Kenya
- Kisumu District Hospital
-
Kisumu, Kenya
- Lumumba
-
Kisumu, Kenya
- Railways
-
Kisumu, Kenya
- Nyang'Ande
-
Kisumu, Kenya
- Pandipieri
-
Migori, Kenya
- Osingo
-
Migori, Kenya
- Suna Ragana
-
Migori, Kenya
- Minyenya
-
Migori, Kenya
- Muhuru Bay
-
Migori, Kenya
- Ngodhe
-
Migori, Kenya
- Nyamasare
-
Migori, Kenya
- Oyani
-
Migori, Kenya
- Sori Lakeside
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Compound/homesteads are eligible to participate if it has an adult who is a participant in the parent study, Households within the compound/homesteads are eligible if it has (1) a resident related to the adult participant in the parent study, (2) >1 child(ren) 6- to 36-months old, (3) the child(ren) have a parent/primary guardian age >18 years old who resides in the compound/homestead, (4) the caregiver intends to stay in the study area for the next 24 months with the child.
- Children: Age 6- to 36-months old, resident in a household in the compound/homestead of participant in the parent study. Adults: Parent or guardian of eligible child, age >18 years old, is the primary caregiver for the child(ren), and is either a participant in parent study or resident in compound/homestead of participant in the parent study.
Exclusion Criteria:
- Households in which no resident is related to the adult participant in the parent study (e.g., non-relative renters) because unrelated household members would not be expected, in Luo society, to share human, financial, or food resources with the index participant. These situations are rare in Nyanza Region.
- Children who have severe malnutrition (below -3 z-scores of the median WHO growth standards).180 Children with severe malnutrition will be excluded because they will be referred for intensive care, including feeding support.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Control Arm
|
|
Experimental: Multisectoral Agriculture and Microfinance Arm
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Weight for Length Z Score
Time Frame: 24 months
|
Weight in KG, Length in CM
|
24 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Morbidity
Time Frame: 24 months
|
Number of incident respiratory and diarrheal illnesses in prior 2 weeks
|
24 months
|
Neurobehavioral Development
Time Frame: 24 months
|
Cognitive, Motor, and Social Development Score Using the Profile for Child Monitoring Measure
|
24 months
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Other Study ID Numbers
- H16-101UCSF
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Child Nutrition, Child Neurobehavioral Development
-
The Hospital for Sick ChildrenNot yet recruitingParenting | Early Child Development | Child Nutrition | Child Eating BehavioursCanada
-
Project Concern InternationalHarvard School of Public Health (HSPH); Purdue University; National Institute... and other collaboratorsCompletedChild Nutrition and Early Child DevelopmentTanzania
-
Boston CollegeGrand Challenges Canada; InfaCare Pharmaceuticals Corporation, a Mallinckrodt... and other collaboratorsActive, not recruitingParent-Child Relations | Parenting | Child Development | Child MalnutritionRwanda
-
International Food Policy Research InstituteCornell University; Data Analysis and Technical Assistance Ltd; World Food Programme...CompletedChild Development | Intimate Partner Violence | Food Security | Poverty | Child Nutrition | Gender Dynamics
-
Washington University School of MedicineHôpital Universitaire Justinien; Université Publique du Nord au Cap-Haïtien; Konbit...RecruitingParenting | Malnutrition, Child | Development, ChildHaiti
-
TruHeight VitaminsSan Francisco Research InstituteCompletedBody Weight | Growth Disorders | Child Development | Dietary Exposure | Child Malnutrition | Bone Development AbnormalUnited States
-
The Hospital for Sick ChildrenAga Khan University; March of DimesCompletedChild Development | Child Mortality | Child Morbidity | Child BehaviourPakistan
-
University of Southern CaliforniaSafe Water and AIDS Project (SWAP); Early Childhood Development Network for...RecruitingChild Behavior | Child Development | Language, ChildKenya
-
Windward Islands Research and Education FoundationGrand Challenges Canada; St. George's University; GRENCASECompletedDevelopment, Child | Behavior, Child | Neurocognition, ChildGrenada
-
Boston Medical CenterCenter for the Study of Social PolicyCompletedChild Abuse | Parenting | Child Development | Child Rearing | Child NeglectUnited States
Clinical Trials on Multisectoral agriculture and Microfinance Intervention
-
London School of Hygiene and Tropical MedicineDepartment for International Development, United Kingdom; University of Witwatersrand... and other collaboratorsCompletedHIV Infections | Gender Based ViolenceSouth Africa
-
Johns Hopkins UniversityEunice Kennedy Shriver National Institute of Child Health and Human Development...CompletedMental Health DisordersCongo
-
University of North Carolina, Chapel HillNational Institute of Mental Health (NIMH); American University; Muhimbili University...CompletedSexually Transmitted Infections | Domestic ViolenceUnited States
-
Tanzania Food and Drugs AuthorityUniversity Ghent; International Foundation for Science (IFS); The Nelson Mandela... and other collaboratorsCompleted
-
Columbia UniversityNational Institute on Drug Abuse (NIDA)CompletedHIV/AIDS and InfectionsKazakhstan
-
RANDGrand Challenges Canada; Danang Psychiatric Hospital; Basic Needs VietnamCompleted
-
University of South CarolinaHelen Keller InternationalCompleted
-
McGill UniversityWorld Vision; Foreign Affairs, Trade and Development, CanadaCompleted
-
London School of Economics and Political ScienceCompleted
-
Sabine GabryschGerman Research Foundation; German Federal Ministry of Education and Research; Department for International Development, United Kingdom and other collaboratorsCompleted