Assessing the effects of a multisectoral agricultural intervention on the reproductive and sexual health of adolescent girls and young women

PROJECT SUMMARY/ABSTRACT: In Kenya, HIV incidence among adolescent girls and young women (AGYW) ages 15-24 years is 1-2 per 100 person-years and approximately 30% of AGYW have had at least one sexually transmitted infection (STI). Kisumu, Homa Bay, and Migori counties in Western Kenya have the highest HIV/STI incidence in the country. Food insecurity (Fl) and poverty are also highly prevalent in Western Kenya. Fl and poverty are important drivers of vulnerability to HIV and STls among AGYW. Poverty alleviation interventions have the potential to reduce STls and HIV risk among AGYW but, to date, these interventions have reported mixed findings on HIV/STI outcomes, have been primarily targeted at the individual level, and none have focused on agriculture or Fl. Therefore, there remains a critical need to develop sustainable, multi-level, economic and Fl interventions that improve AGYW STI/HIV prevention outcomes. Our team has successfully developed a household-level agricultural intervention in Western Kenya called Shamba Maisha ("farm life" in Kiswahili; SM) to reduce household Fl. In our prior pilot study with AGYW, we found that SM was feasible, acceptable, and associated with less Fl and improved mental health. In this proposal, we will build upon our promising SM work by examining the effectiveness and implementation of our SM intervention, including provision of a water pump and agricultural implements for use at home, training in farming agriculture delivered at school-based demonstration farms, and adolescent-caregiver relationship strengthening training. We plan to conduct this school- and home-based cluster randomized trial with 800 AGYW and their primary caregivers recruited from schools in Kisumu, Homa Bay, and Migori counties. We will randomize 20 schools in Western Kenya to intervention or control conditions and follow AGYW-caregiver dyads for 18 months with surveys and STl/pregnancy testing to assess intervention impacts. In Aim 1, we will determine the impact of SM on adolescent HIV prevention and sexual and reproductive health outcomes (primary outcome is gonorrhea and/or chlamydia incidence). In Aim 2, we will assess the effect of SM on intermediate outcomes theorized from our published conceptual framework to be on the causal pathway, including household food security and wealth, and adolescent and caregiver factors including mental health and aspects of the caregiver-AGYW relationship dyad (e.g., communication). In Aim 3, we will identify critical implementation facilitators and barriers influencing SM effectiveness and delivery and conduct a programmatic cost assessment. We will also evaluate the extent to which SM can have "spillover'' nutritional benefits for a larger population of adolescents who had access to demonstration farms at intervention schools but did not receive other aspects of the intervention. Our ultimate goal is to provide an innovative household-level intervention to halt the cycle of Fl, and poor HIV-related outcomes among vulnerable populations including AGYW, consistent with the "Ending the HIV Epidemic" and Sustainable Development Goals.