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.

AGYW in intervention households had significantly less food insecurity compared to those in control households at trial end.

• OR: 0.45, 95% CI 0.21 to 0.97; p=0.04
• The study enrolled 241 AGYW-caregiver pairs (n=131 intervention)
• Median age of AGYW was 15 years old (IQR: 14-17 years old)
• Analysis used logistic regression accounting for clusters with robust standard errors

AGYW in intervention households had lower depressive symptomatology compared to control households, though the difference did not reach conventional statistical significance.

• OR: 0.53; 95% CI 0.24 to 1.15, p=0.11
• This was the primary analysis among all 241 AGYW-caregiver pairs
• A stronger effect was observed in the secondary analysis restricted to 15-19 year olds

There was no significant difference in unprotected sex between intervention and control AGYW in the primary analysis.

• OR: 1.16; 95% CI 0.63 to 2.16; p=0.63
• Analysis was conducted at trial end among all enrolled AGYW-caregiver pairs
• Linear and logistic regressions were used to compare differences between arms

In the secondary analysis among 15-19 year old AGYW whose caregivers were Shamba Maisha participants, intervention AGYW had significantly higher body mass index than control AGYW.

• β: 1.25; SE: 0.32; p=0.002
• Secondary analysis was restricted to AGYW aged 15-19 years
• This nutritional improvement suggests the livelihood intervention had measurable physical health benefits for adolescents

In the secondary analysis among 15-19 year olds, intervention AGYW had significantly fewer symptoms of depression than control AGYW.

• OR: 0.42; 95% CI 0.21 to 0.84; p=0.01
• This effect was stronger than that observed in the primary analysis (OR: 0.53, p=0.11)
• Secondary analysis focused on AGYW aged 15-19 years whose caregivers were SM participants

In the secondary analysis among 15-19 year olds, intervention AGYW had fewer symptoms of anxiety than control AGYW, though this did not reach conventional statistical significance.

• OR: 0.23, 95% CI 0.05 to 1.11; p=0.07
• The wide confidence interval suggests limited precision, possibly due to smaller sample size in the secondary analysis
• Analysis accounted for clusters with robust standard errors

In the secondary analysis among 15-19 year olds, intervention AGYW experienced significantly less sexual intimate partner violence than control AGYW.

• OR: 0.28; 95% CI 0.08 to 0.91; p=0.03
• This represents a roughly 72% lower odds of sexual IPV in the intervention arm
• Sexual IPV was assessed as a sexual and reproductive health outcome among AGYW

Intervention arm caregivers had significantly less food insecurity than those in the control arm.

• OR: 0.05; 95% CI 0.0047 to 0.54; p=0.014
• Caregivers were adults living with HIV enrolled in the Shamba Maisha trial
• The very low odds ratio and wide confidence interval suggest a strong but imprecisely estimated effect
• This finding was based on the AGYW-caregiver pair analysis

The Shamba Maisha intervention was a cluster randomised controlled trial of a multisectoral agricultural livelihood intervention designed to improve HIV health among adults living with HIV in western Kenya.

• The trial was registered as NCT03741634
• The intervention was designed to address household-level factors including food insecurity and poverty
• The study assessed AGYW living in households of adults enrolled in Shamba Maisha
• The study enrolled 241 AGYW-caregiver pairs with 131 in the intervention arm