Introduction
Methods
Overview of SAGE4Health and the CARE Malawi SAFE Intervention
Overview of the Study Design
Study Setting
SAGE4Health Procedures
Assessment
HIV Testing and Status Outcomes and HIV Risk Behavior
Economic Outcomes
Food Security Outcomes
Sample Size
Statistical Methods
Results
Participants
Intervention Implementation Fidelity
Descriptive data
Participant Characteristics
Characteristics | SAFE participant sample | P value | Random community sample | P value | ||
---|---|---|---|---|---|---|
Demographics | SAFE intervention | Control group | SAFE intervention area | Control area | ||
N = 598 | N = 301 | N = 501 | N = 501 | |||
Female participants (%) | 398 (66.6) | 201 (66.8) | .947 | 334 (66.7) | 327 (65.5) | .704 |
Mean age of respondent in years (range) | 40.4 (18–84) | 38.5 (19–86) | .040 | 38.6 (17–84) | 38.2 (3–98) | .658 |
Mean household size (range) | 5.3 (1–11) | 6.3 (2–14) | .001 | 4.6 (1–13) | 4.9 (1 –12) | .021 |
Male head of household | 495 (82.8) | 265 (88.0) | .039 | 402 (80.2) | 421 (84.2) | .101 |
Head of household literate | 472 (78.9) | 236 (78.4) | .856 | 375 (75.2) | 363 (72.9) | .416 |
Marital status | .085 | .021 | ||||
Currently married/living together | 492 (82.3) | 261 (86.7) | 385 (77.0) | 404 (80.8) | ||
Separated | 21 (3.5) | 9 (3.0) | 18 (3.6) | 8 (1.6) | ||
Divorced | 19 (3.2) | 11 (3.7) | 48 (9.6) | 27 (5.4) | ||
Widowed | 54 (9.0) | 20 (6.6) | 44 (8.8) | 54 (10.8) | ||
Never married | 12 (2.00) | 0 (0) | 5 (1.0) | 7 (1.4) | ||
Education (highest level of school) | .122 | .353 | ||||
Primary | 447 (74.7) | 225 (74.8) | 366 (73.2) | 383 (76.9) | ||
Secondary | 81 (13.5) | 28 (9.3) | 62 (12.4) | 49 (9.8) | ||
University | 0 (0) | 0 (0) | 0 (0) | 1 (0.2) | ||
Other | 2 (0.3) | 1 (0.3) | 0 (0) | 0 (0) | ||
Never went to school | 68 (11.4) | 47 (15.6) | 72 (14.4) | 65 (13.1) | ||
Have multiple spouses (%) | 68 (21.8) | 41 (24.3) | .537 | 42 (16.7) | 57 (22.5) | .097 |
No response | 286 | 132 | 249 | 248 |
Main Results
Expected change in intervention compared to control | Intervention | Control | |||||
---|---|---|---|---|---|---|---|
Baseline | 18 months | 36 months | Baseline | 18 months | 36 months | ||
Longitudinal data | |||||||
HIV vulnerability | |||||||
Reported HIV testing | Increase | 292/564 (51.8 %) | 400/563 (71.0 %) | 368/492 (74.8 %) | 169/263 (64.3 %) | 179/263 (68.1 %) | 145/200 (72.5 %) |
Female reported HIV testing | Increase | 200/373 (53.6 %) | 277/373 (74.3 %) | 239/315 (75.9 %) | 117/172 (67.6 %) | 125/173 (72.3 %) | 93/119 (78.2 %) |
Male reported HIV testing | Increase | 92/191 (48.2 %) | 123/190 (64.7 %) | 129/177 (72.9 %) | 52/90 (57.8 %) | 54/90 (60.0 %) | 52/81 (64.2 %) |
Self-reported HIV-Positive status | Increase | 16/564 (2.8 %) | 32/564 (5.7 %) | 33/564 (5.9 %) | 9/263 (3.4 %) | 10/263 (3.8 %) | 9/263 (3.4 %) |
Economic crisis and ganyu involvement | |||||||
Economic crises due to illness/hospitalization | Decrease | 343/562 (61 %) | 323/564 (57.3 %) | 261/562 (46.4 %) | 120/263 (45.6 %) | 163/263 (62.0 %) | 153/263 (58.2 %) |
Economic crises due to environmental disaster | Decrease | 88/559 (15.7 %) | 16/563 (2.8 %) | 20/562 (3.6 %) | 12/263 (4.6 %) | 7/263 (2.7 %) | 11/263 (4.2 %) |
Adult engaged in ganyu | Decrease | 290/564 (51.4 %) | 346/564 (61.3 %) | 337/563 (59.9 %) | 111/263 (42.2 %) | 159/263 (60.5 %) | 165/263 (62.7 %) |
Child engaged in ganyu | Decrease | 85/553 (15.4 %) | 99/562 (17.6 %) | 98/552 (17.8 %) | 39/260 (15.0 %) | 55/261 (21.1 %) | 71/262 (27.1 %) |
Food Security | |||||||
Household food security | Increase | 165/564 (29.3 %) | 309/564 (54.8 %) | 308/531 (58.0 %) | 71/262 (27.1 %) | 117/263 (44.5 %) | 129/245 (52.7 %) |
Consuming vitamin A-rich vegetables | Increase | 536/586 (95.0 %) | 522/564 (92.6 %) | 472/481 (98.1 %) | 248/263 (94.3 %) | 260/263 (98.9 %) | 236/245 (96.3 %) |
Consuming other vegetables | Increase | 426/564 (75.5 %) | 471/564 (83.5 %) | 504/531 (94.9 %) | 198/263 (75.3 %) | 189/263 (71.9 %) | 228/244 (93.4 %) |
Consuming vitamin A-rich fruits | Increase | 27/564 (4.8 %) | 248/564 (44.0) | 160/531 (30.1 %) | 47/263 (17.9 %) | 49/262 (18.7 %) | 95/245 (38.8 %) |
Consuming groundnuts | Increase | 396/563 (70.3 %) | 455/564 (80.7 %) | 405/563 (71.9 %) | 191/262 (72.9 %) | 188/263 (71.5 %) | 202/262 (77.1 %) |
Reducing amount and number of meals to cope with food shortage | Decrease | 59/398 (14.8 %) | 15/252 (6.0 %) | 15/197 (7.6 %) | 17/191 (8.9 %) | 17/146 (11.6 %) | 7/116 (6.0 %) |
Anthropometric measurements (malnutrition status of children) | Decrease | 62/420 (14.8 %) | 54/322 (16.8 %) | 64/344 (18.6 %) | 48/213 (22.5 %) | 37/187 (19.8 %) | 47/194 (24.2 %) |
Odds Ratio (95 % CI) | |||||
---|---|---|---|---|---|
Expected change in intervention compared to control | Baseline to 18 months | P value | Baseline to 36 months | P value | |
HIV vulnerability | |||||
Reported HIV testing | Increase | 1.93 (1.45–2.58) | .001 | 1.90 (1.29–2.78) | <.001 |
Female reported HIV testing | Increase | 2.00 (1.40–2.86) | <.001 | 1.70 (1.03–2.82) | .039 |
Male reported HIV testing | Increase | 1.81 (1.10–2.99) | .019 | 2.12 (1.16–3.89) | .015 |
Self-reported HIV-Positive status | Increase | 1.85 (1.09–3.14) | .023 | 2.13 (1.07–4.22) | .030 |
Economic crises and ganyu involvement | |||||
Had economic crises due to illness/ hospitalization | Decrease | .44 (.31–.62) | <.001 | .34 (.23–.50) | <.001 |
Had economic crises due to environmental disaster | Decrease | .27 (.09–.79) | .017 | .22 (.08–.56) | .002 |
Adult engaged in ganyu | Decrease | .72 (.51–.99) | .049 | .61 (.42–.87) | .007 |
Child engaged in ganyu | Decrease | .78 (.50–1.22) | .283 | .55 (.34–.88) | .012 |
Food security | |||||
Household food security (binary measure: yes vs. no) | Increase | 1.36 (.93–1.97) | .108 | 1.12 (.75–1.67) | .585 |
Household food insecurity (actual counts of self-reported months (0–12) suffered from food insecurity) | Decrease | .79 (.64–.97) | .026 | .74 (.63–.87) | <.001 |
Consuming vitamin A-rich vegetables | Increase | .12 (.03–.45) | .001 | 1.75 (.56–5.44) | .334 |
Consuming other vegetables | Increase | 1.96 (1.27–3.02) | .002 | 1.29 (.64–2.60) | .479 |
Consuming vitamin A-rich fruits | Increase | 14.8 (8.15–26.80) | <.001 | 2.92 (1.65–5.17) | <.001 |
Consuming groundnuts | Increase | 1.90 (1.29–2.80) | .001 | .87 (.58–1.29) | .482 |
Reducing amount and number of meals to cope with food Shortage | Decrease | .27 (.11–.67) | .005 | .72 (.24–2.10) | .542 |
Anthropometric measurements (malnutrition status of children) | Decrease | 1.52 (.80–2.90) | .205 | 1.27 (.54–3.01) | .585 |
Intervention area | Control area | |||
---|---|---|---|---|
Baseline | 36-month | Baseline | 36-month | |
HIV Vulnerability | ||||
Reported HIV testing | 64.7 % (323/499) | 74.2 % (264/356) | 58.6 % (291/497) | 69.6 % (250/359) |
Female reported HIV testing | 64.8 % (215/332) | 75.6 % (155/205) | 59.1 % (191/323) | 73.3 % (148/202) |
Male reported HIV testing | 64.7 % (108/167) | 68.3 % (82/120) | 58.1 % (100/172) | 65.3 % (79/121) |
Self-reported HIV-Positive status | 4.2 % (21/501) | 4.3 % (21/490) | 2.0 % (10/501) | 2.4 % (11/460) |
Economic crisis and ganyu involvement | ||||
Had economic crises due to illness/hospitalization | 54.1 % (271/501) | 54.0 % (301/557) | 43.3 % (217/501) | 43.7 % (221/506) |
Had economic crises due to environmental disaster | 2.0 % (10/501) | 2.2 % (12/557) | 3.2 % (16/501) | 3.2 % (16/506) |
Adult engaged in ganyu | 54.2 % (271/500) | 61 % (264/433) | 50.1 % (251/501) | 66.7 % (301/460) |
Child engaged in ganyu | 12.6 % (63/499) | 14.3 % (68/477) | 8.8 % (43/488) | 14.9 % (67/451) |
Food security | ||||
Household food security | 24.6 % (123/501) | 41.4 % (189/456) | 23.2 % (116/500) | 37.2 % (165/444) |
Consuming vitamin A-rich vegetables | 94.2 % (472/501) | 94.1 % (524/557) | 91.6 % (459/501) | 91.7 % (464/506) |
Consuming other vegetables | 52.3 % (262/501) | 50.4 % (281/557) | 44.5 % (223/501) | 44.7 % (226/506) |
Consuming vitamin A-rich fruits | 13.2 % (66/501) | 33.1 % (170/514) | 47.7 % (239/501) | 55.9 % (251/449) |
Consuming groundnuts | 59.9 % (300/501) | 62.0 % (303/489) | 58.9 % (295/501) | 59.8 % (275/460) |
Reducing amount and number of meals to cope with food shortage | 17.9 % (68/379) | 20.1 % (103/510) | 25.7 % (98/382) | 27.8 % (125/450) |
Anthropometric measurements (malnutrition status of children) | 18.7 % (49/262) | 19.1 % (50/261) | 20.9 % (78/373) | 22.8 % (84/369) |