Abstract
The objective of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) study was to evaluate the impact of a large-scale multi-level economic and food security intervention on health outcomes and HIV vulnerability in rural Malawi. The study employed a quasi-experimental non-equivalent control group design to compare intervention participants (n = 598) with people participating in unrelated programs in distinct but similar geographical areas (control, n = 301). 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 = 1002) were interviewed in the intervention and control areas at baseline and 36 months. 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 nutritional diversity, and improved economic resilience to shocks. Most effects were sustained over a 3-year period. Further, no significant differences in change were found over the 3-year study period on surveys of randomly selected households in the intervention and control areas. Although there were general trends toward improvement in the study area, only intervention participants’ outcomes were significantly better. Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. Leveraging the resources of economic development NGOs to deliver locally-developed programs with scientific funding to conduct controlled evaluations has the potential to accelerate the scientific evidence base for the effects of economic development programs on health.
Highlights
Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding
No differences were observed in baseline variables for either study conditions in participants retained in the study compared with those unavailable for follow-up
Our data suggest that this multi-level structural intervention addressing poverty and food security may have significant impacts on HIV vulnerability, as well as intended effects on economic stability and food security
Summary
Results indicate the intervention can improve economic and food security and HIV vulnerability through increased testing and case finding. We present the main outcomes of the Savings, Agriculture, Governance, and Empowerment for Health (SAGE4Health) intervention study, including HIV vulnerability, food security, and economic stability. The primary study hypotheses were that the intervention group would improve relative to the comparison group on measures of HIV vulnerability, food security, and economic stability at the 18- and 36-month follow-ups. Microfinance or microlending [5] has the potential to help low income individuals access credit and become economically stable, which may result in improvements in health-related outcomes such as decreased intimate partner violence and unprotected sex [6, 7], lower pregnancy rates [8, 9], and decreased prevalence of sexually transmitted infections [10]. Village savings and loans (VS&L) group participation has the potential for impact along multiple causal pathways to HIV vulnerability [11,12,13]; inconsistent findings prompt the need for more evaluation [14,15,16]
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