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Outcomes of a large-scale multilevel economic and food security structural intervention on HIV vulnerability in rural Malawi: The SAGE4Health Study
Methods: The SAGE4Health study employed a quasi-experimental non-equivalent control group design to compare intervention participants (N=600) with people participating in unrelated programs in distinct but similar geographical areas (control, N=300). 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=1000) were interviewed in the intervention and control areas at baseline and 36 months to control for historical trends and geographical confounds.
Results: 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 STI diagnoses, and improved economic resilience to shocks. Most effects were sustained over a 3-year period.
Conclusions: These results cannot be explained by more general trends during the study timeframe. Although there were general trends toward improvement in the study area, only intervention participants’ outcomes were significantly better. Our study indicates a multi-level structural intervention can improve economic/food security and HIV vulnerability through increased testing and case finding.. We encourage further rigorous, controlled research on the effects of a variety of real-world economic development programs on HIV and other health outcomes. Leveraging the resources of NGOs to deliver locally developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the likelihood of positive impacts of economic programs on health.
Learning Areas:
Conduct evaluation related to programs, research, and other areas of practicePublic health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health
Learning Objectives:
Describe the main outcomes of a large-scale multilevel economic and food security structural intervention on HIV vulnerability in rural Malawi
Identify a funding model and research design that leverages strengths of both non-governmental organizations and academia
Keyword(s): HIV/AIDS, Practice-Based Research
Qualified on the content I am responsible for because: I am the Co-Principal Investigator of the NIH grant that funded the project described in the abstract. I have an M.D., M.P.H. and have been conducting public health and global health research for 25 years.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.