Harvesting health: Fertilizer, nutrition and AIDS treatment in Kenya

This thesis explores various policy options for mitigating food insecurity among patients receiving treatment for HIV/AIDS. The first chapter examines the impact of a fertilizer provision program that targets farming households in which one or more members is currently receiving treatment for AIDS. The study enrolled 540 patients, of which half were selected to receive free fertilizer for the 2007 planting season. I find that treated households planted a larger acreage and produced 350 more kilograms of maize than control households, an increase of 40% worth about 88 USD. Treated households used the increased income from crop sales to invest in livestock and purchase 80% more fertilizer than the control group in the subsequent planting season. The second chapter extends the analysis of the impact of the fertilizer program to examine health outcomes of program participants. Fertilizer recipients, who concurrently received free anti-retroviral therapy (ART), experienced significant health improvements. Fertilizer provision improved the health status of treated individuals, as measured by both body mass index (BMI) and CD4 cell count. In the third chapter, I examine the impact of direct food distribution on the clinical outcomes of patients receiving ART at one clinic within the USAID-AMPATH partnership in western Kenya. The nutrition supplementation program began in 2004 and targeted patients with low Body Mass Index (BMI) and severe immunological suppression, as measured by CD4 cell count. Of the 1977 patients who initiated ART at this clinic, 548 participated in the food supplementation program. Results indicate that while both groups respond equally well to ART, the addition of food does not appear to significantly improve the outcomes of food recipients over the first 18 months of treatment. However, these results must be interpreted with caution due to the small sample size of CD4 and BMI measurements beyond the first 6 months of treatment. More rigorous evaluation, preferably with experimental design, of the impact of nutrition programs on the health outcomes of ART patients is needed