Abstract
BackgroundThere is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs.MethodsThis analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey.ResultsProviding LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished.ConclusionsCost outcomes were 20–30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.
Highlights
Nutrition status is an important factor in the etiology and progression of HIV
This paper examines an intervention providing home gardens to people living with HIV (PLHIV) in Zimbabwe, one of the Sub-Saharan African countries most affected by HIV and AIDS, with an estimated prevalence among adults of 13% [19]
Analytical strategy This study used mixed methods to assess, from a societal perspective, the total cost and cost-effectiveness of low input gardens (LIGs) as a strategy for improving the food consumption and dietary diversity of PLHIV in five wards of Chipinge District, relative to comparator households of PLHIV participating in other support programs but not in LIGs
Summary
Nutrition status is an important factor in the etiology and progression of HIV. Nutrition and immunity are linked, with impaired immune function from suboptimal nutrition status hastening progression of HIV [1]. Poor nutrition status is an independent predictor of mortality for PLHIV undergoing antiretroviral therapy (ART), and adequate diet has been shown to improve adherence to ART [5,6]. Poor diet quality has been linked with disease severity and mortality outcomes among PLHIV [7]. PLHIV often suffer from social and economic losses due to the costs of the disease and need support in terms of income generating activities and social empowerment. There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs
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