{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T22:38:07Z","timestamp":1787870287650,"version":"build-2784847793"},"reference-count":48,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Food insecurity and HIV health outcomes are linked through nutritional, mental health, and health behavior pathways.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the effects of a multisectoral agriculture and livelihood intervention on HIV viral suppression and nutritional, mental health, and behavioral outcomes among HIV-positive adults prescribed antiretroviral therapy (ART).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cluster randomized clinical trial was performed in 8 pairs of health facilities in Kenya. Participants were 18 years or older, living with HIV, and receiving ART for longer than 6 months; had moderate to severe food insecurity; and had access to arable land and surface water and\/or shallow aquifers. Participants were followed up every 6 months for 24 months. Data were collected from June 23, 2016, to June 13, 2017, with follow-up completed by December 16, 2019. Data were analyzed from June 25 to August 31, 2020, using intention-to-treat and per-protocol methods.<\/jats:p><\/jats:sec>Interventions<\/jats:title>A loan to purchase a human-powered irrigation pump, fertilizer, seeds, and pesticides combined with the provision of training in sustainable agriculture and financial literacy.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the relative change from baseline to the end of follow-up in viral load suppression (\u2264200 copies\/mL) compared between study groups using difference-in-differences analyses. Secondary outcomes included clinic attendance, ART adherence, food insecurity, depression, self-confidence, and social support.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 720 participants were enrolled (396 women [55.0%]; mean [SD] age, 40.38 [9.12] years), including 366 in the intervention group and 354 in the control group. Retention included 677 (94.0%) at the 24-month visit. HIV viral suppression improved in both groups from baseline to end of follow-up from 314 of 366 (85.8%) to 327 of 344 (95.1%) in the intervention group and from 291 of 353 (82.4%) to 314 of 333 (94.3%) in the control group (P<\/jats:italic>\u2009=\u2009.86). Food insecurity decreased more in the intervention than the control group (difference in linear trend,\u2009\u22123.54 [95% CI, \u22124.16 to \u22122.92]). Proportions of those with depression during the 24-month follow-up period declined more in the intervention group (from 169 of 365 [46.3%] to 36 of 344 [10.5%]) than the control group (106 of 354 [29.9%] to 41 of 333 [12.3%]; difference in trend,\u2009\u22120.83 [95% CI, \u22121.45 to \u22120.20]). Self-confidence improved more in the intervention than control group (difference in trend,\u2009\u22120.37 [95% CI, \u22120.59 to \u22120.15]; P<\/jats:italic>\u2009=\u2009.001), as did social support (difference in trend,\u2009\u22123.63 [95% CI, \u22124.30 to \u22122.95]; P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cluster randomized trial, the multisectoral agricultural intervention led to demonstrable health and other benefits; however, it was not possible to detect additional effects of the intervention on HIV clinical indicators. Agricultural interventions that improve productivity and livelihoods hold promise as a way of addressing food insecurity and the underpinnings of poor health among people living with HIV in resource-limited settings.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02815579<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2022.46158","type":"journal-article","created":{"date-parts":[[2022,12,12]],"date-time":"2022-12-12T16:00:40Z","timestamp":1670860840000},"page":"e2246158","source":"Crossref","is-referenced-by-count":28,"title":["Effect of a Multisectoral Agricultural Intervention on HIV Health Outcomes Among Adults in Kenya"],"prefix":"10.1001","volume":"5","author":[{"given":"Craig R.","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San 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