Background:
Agricultural interventions to address food insecurity have been shown to improve HIV health outcomes through nutritional, mental health, and health behavior pathways, but little is known about their costs and cost-effectiveness
Methods:
We estimated costs and incremental cost-effectiveness of implementing a multisectoral agricultural intervention (Shamba Maisha) compared to control within a cluster-randomized trial in 8 matched health facilities during 2016-2019. Shamba Maisha included loans to purchase a human-powered irrigation pump, fertilizer, seeds and pesticides, and provision of training in sustainable agriculture and financial literacy. Participants were adults in HIV care at participating clinics who were followed for 24 months. We estimated cost per person using site visits, conversations with study coordinators, micro-costing techniques, a time-and-motion personnel study, and administrative record review. Costs were categorized into capital goods, personnel costs, and recurrent goods and services. We observed effects of the intervention on food insecurity, depression, and social support among participants and length/height for age among their young children (aged 6-23.9 months). Results from the study were translated into disability-adjusted life years (DALYs) averted. We estimated the incremental cost per DALY averted among participants and their young children in the intervention compared to those in the control arm.
Results:
Participants included 720 adults with HIV (366 intervention, 354 control). Results were also assessed among 207 young children (95 intervention, 112 control). Overall, the incremental cost of implementation of Shamba Maisha compared to control was $642 per person ($841 intervention, $199 control). This included an added cost per person of $209 for capital goods, $387 for personnel salaries and benefits, $22 for recurring goods, and $24 for recurring services. The intervention averted an estimated 0.158 DALYs per person, including 0.027 DALYs for decreased food insecurity, 0.053 for decreased depression, 0.044 for increased social support, and 0.034 for greater length/height for age among young children. The overall incremental cost-effectiveness ratio was $4027 per DALY averted
Conclusions:
The Shamba Maisha multisectoral agricultural intervention was cost-effective based on the WHO threshold of three times the annual GDP per capita ($6020 USD in 2021). Future analyses will account for reduced health care costs associated with improved health outcomes.