What question did this study set out to answer?

To assess the impact of an agricultural livelihood intervention on health outcomes among HIV-affected adolescents.

March 28, 2026Open Access

A livelihood intervention improved nutritional, mental health and sexual health outcomes among HIV-affected adolescents in western Kenya: results from the Shamba Maisha randomised controlled trial

SWSheri D. WeiserUniversity of California, San Francisco LSLila Aziz SheiraUniversity of California, San Francisco PWPauline WekesaKenya Medical Research Institute

Key Points

To assess the impact of an agricultural livelihood intervention on health outcomes among HIV-affected adolescents.
Conducted a cluster randomized controlled trial in Western Kenya.
Evaluated adolescent girls and young women living in households of adults enrolled in the intervention.
Used linear and logistic regressions to analyze differences in health outcomes.
Intervention led to reduced food insecurity among adolescents (OR: 0.45).
Lower depressive symptoms observed in intervention group (OR: 0.42).
Higher body mass index noted among intervention AGYW (β: 1.25).
Reduction in intimate partner violence was significant (OR: 0.28).
Caregivers in the intervention experienced less food insecurity (OR: 0.05).

Abstract

Introduction Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW). Methods This cluster randomised controlled trial in Kenya assessed AGYW living in households of adults enrolled in Shamba Maisha (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control arms in FI, and mental health among AGYW-caregiver pairs and SRH outcomes among the AGYW, accounting for clusters with robust standard errors. We also conducted a secondary analysis among 15–19 years whose caregivers were SM participants. Results The study enrolled 241 AGYW-caregiver pairs (n=131 intervention). The median age of AGYW was 15 years old (IQR: 14–17 years old). At endline, AGYW in intervention households had less FI (OR: 0.45, 95% CI 0.21 to 0.97; p=0.04), lower depressive symptomatology (OR: 0.53; 95% CI 0.24 to 1.15, p=0.11) and no difference in unprotected sex (OR: 1.16; 95% CI 0.63 to 2.16; p=0.63) compared with those in control households. In the secondary analysis, intervention AGYW had higher body mass index (β: 1.25; SE: 0.32; p=0.002), fewer symptoms of depression (OR: 0.42; 95% CI 0.21 to 0.84; p=0.01) and anxiety (OR: 0.23, 95% CI 0.05 to 1.11; p=0.07), and less sexual intimate partner violence (IPV) (OR: 0.28; 95% CI 0.08 to 0.91; p=0.03) than control AGYW. Intervention arm caregivers had less FI than those in the control arm (OR: 0.05; 95% CI 0.0047 to 0.54; p=0.014). Conclusions An agricultural livelihood intervention among adults living with HIV improved FI, mental health and IPV outcomes among AGYW in their households. These findings will guide the scale-up of an agricultural livelihood intervention for HIV-affected households with AGYW in sub-Saharan Africa. Trial registration number NCT03741634 .

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