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HIV/AIDS negatively impacts poverty alleviation and food security, which reciprocally hinder the rapid scale up and effectiveness of HIV care programs. Nyanza province has the highest HIV prevalence (15.3%), and is the third highest contributor (2.4 million people) to rural poverty in Kenya. Thus, we tested the feasibility of providing a micro-irrigation pump to HIV-positive farmers in order to evaluate its impact on health and economic advancement among HIV-positive patients and their families. Methods. Thirty HIV-positive patients enrolled in the Family AIDS Care and Education Services (FACES) program in Kisumu, Kenya were provided a micro-financed loan to receive an irrigation pump and farming guidance from KickStart, the developer of the pump. Economic data, CD4 counts, household health and loan repayment history were collected 12 months after the pumps were distributed. Results. Mean annual family income increased by $1,332 over baseline. CD4 counts did not change significantly. Though income increased, only three (10%) participants had paid off more than a quarter of the loan. Conclusions. We demonstrated the feasibility of an income-generating micro-irrigation intervention among HIV-positive patients and the collection of health and economic data. While family income improved significantly, loan repayment rates were low- likely complicated by the drought that occurred in Kenya during the intervention period. © 2010 Pandit et al; licensee BioMed Central Ltd.
Family AIDS Care and Education Services (FACES) is an HIV care and treatment program in Kenya managed by the Kenya Medical Research Institute (KEMRI) and the University of California, San Francisco (UCSF), funded through the US President’s Emergency Plan for AIDS Relief (PEPFAR). Since 2004, FACES has offered services in the diagnosis and treatment of HIV and related illnesses in addition to counseling, support groups, and peer education free of charge. In 2005, FACES expanded to Kisumu (the 3rd largest city in Kenya located on Lake Victoria) at the Lumumba Health Center, Kisumu’s busiest maternal health facility. Between February 2007 and July 2007, community health counselors from the FACES program recruited thirty FACES patients from the Lumumba Health Center in Kisumu, Kenya. Eligibility requirements to receive a loan included participation in FACES treatment program, ability to make a down payment of 600 Kenya shillings (Ksh), approximately US $8, and access to land with an adjacent supply of surface water for farming. The KEMRI Ethical Review Committee and UCSF Committee on Human Research reviewed and approved the study protocol. Eligible participants were counseled on the details of the project and asked to sign a commitment contract. In addition, all participants signed a written informed consent form. After commitment, the farmer received a local purchase order (LPO) to obtain their inputs from the Mwanga Agrovet (a local store). The inputs included: KickStart’s MoneyMaker Hip Pump, a hose pipe, an inlet pipe, seeds, fertilizer, and pesticides. Farmers were able to choose seeds from an assorted range of different vegetable crops to plant. These crops were recommended by other farmers and support group members as successful in the area and approved by FACES and KickStart field experts. The in-kind loan was for approximately 6600 Ksh (US$95). The farmers agreed to repay the loans within a year, during which we anticipated the farmers would have two crop cycles. They were asked to make a down payment of at least 600 Ksh, or approximately 10% of the loan. Though the recruitment communication was primarily with the HIV positive subject, the economic outcome measure was total family income. Thus, it was anticipated that the farming activities would be carried out by the subjects and their families. The project coordinator and FACES counselors conducted initial site visits to train farmers and their families on using the pump, preparing their fields, and planting their seed beds. Thereafter informal quarterly site visits were conducted to ensure proper pump use, follow progress and incomes as well as to provide advice on marketing and sales of vegetables. At the conclusion of the study, eighteen farmers participated in three focus groups, sharing the benefits and challenges of the project and their experiences with loan repayment. Focus groups were divided by gender to allow for consideration of unique experiences between men and women. The groups were facilitated by trained staff. Trained staff of KickStart’s Monitoring and Evaluation (M&E) Unit (Kihia 2003) and staff from FACES interviewed participants at baseline and 12 months after provision of the loan. The questionnaire, administered by the KickStart M&E Unit, evaluated household income, assets, type of housing, land ownership, total irrigated acres of land, types of crops planted, irrigated income, total family income, expenditures and food security at baseline and 12 months. A household survey administered by FACES staff at 12 months collected health and nutrition data of household members, including illnesses in the family during the past month, children’s missed school days for illness, dietary composition, basic hygiene and household water sources. Clinical health data were also assessed at baseline and at 12 months using the FACES patient database. These indicators included body mass index (BMI) and CD4 T-cell counts. Data was entered into Excel 2003 (Microsoft, Renton, WA) and SAS version 9.2 (Cary, NC) was used for statistical analysis. Data were analyzed using Chi-squared test or Fisher’s exact test, as appropriate, and continuous variables were analyzed using the Student’s T-test. To examine the change in BMI and CD4 count from baseline to 12 months, the Cochrane’s test was used. Qualitative data was coded and analyzed by one of the authors (RT).
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