The Sustainable Household Income project (SHIP), began as an extension of the existing Family Treatment Fund program. Family Treatment Fund (FTF) was launched in 2002 as the first free HIV antiretroviral treatment (ART) program in rural southwestern Uganda. Low cost generic ART was provided through private individual donations to the neediest patients for less than a dollar a day. Medical care was provided free through the Mbarara University HIV clinic. A new patient was started on ART when FTF received sufficient funds to secure 5 years of treatment ($2000). Since 2002, FTF has provided ART to over 1000 individuals.
Rational behind the proposed research and Potential benefits to patients and/or society:
Now that ART is more widely available, the ancillary costs of HIV care have emerged as a major barrier to ART treatment success. Securing transportation to pick up monthly ART refills and routine medical evaluations is the most frequent and long-term ancillary cost of care. For many patients in Mbarara, Uganda, the cost of transportation ($2-10 USD) exceeds 30-50% of a family’s total monthly income. This financial demand is added to other ancillary costs of care, such as loss of income and food production during the full day required to attend a medical clinic visit and pick up ART refills. Increased food demands, as people become healthier, also create financial burdens. Like metastatic cancer, advanced AIDS is an appetite suppressant. When malnourished people with advanced AIDS recover on ART, they often develop a severe hunger response due to reversal of the appetite suppressant effects of HIV/AIDS. This hunger response strains household financial resources such that some patients have discontinued ART because they cannot meet the financial demands to provide sufficient food for recovery.
Interrupting ART treatment irreversibly threatens treatment success. Treatment interruptions of several days predictably lead to HIV viral rebound. When the HIV virus rebounds after treatment discontinuation, it becomes rapidly resistant to treatment. Because the cost of “second-line” medications is prohibitive in many resource-poor settings, most patients only have one opportunity for treatment. Failure to meet the ancillary costs of care, which can be $2-5 USD per month, can lead to HIV drug resistance, clinical treatment failure and death. These tragic events are compounded by loss of income production due to care of the ill and dying person living this HIV/AIDS and orphaned dependents.
While FTF has been successful in helping clients regain their strength through providing free ART, it has done little to address broader causes of poverty. FTF clients return to their homes with no means of generating income to support their families despite the return of their physical health and capacity for income generation. Ongoing poverty threatens the very success of the program. FTF hopes to end this cycle of poverty and physical decline by promoting sustainable income generation and financial management strategies through the SHIP Program.
a.Specify objectives and hypothesis to be tested in the research project
SHIP defines its goals in terms of impact on individuals and their households as well as training the next generation of public health leaders in rural Uganda through strengthening the academic mission of MUST. SHIPs goals for individual and household health promotion are to:
1) Help PLWHA meet the ancillary costs of HIV care,
2) Increase survival through sustained and uninterrupted lifelong treatment, and
3) Improve quality of life for the entire household through reduced HIV risk behavior, maternal-child mortality, food insecurity, educational attainment, orphan prevention and household economic development
SHIP’s goals for strengthening the MUST academic mission are to:
1) Create a laboratory for small business management
2) Develop evidence-based programs in:
a. HIV treatment outcomes
b. HIV prevention
c .Maternal-child health
d. Orphan prevention
e. Food insecurity
f. Economic development
SHIP will meet the individual and household health promotion goals through a multifaceted income generation training program combined with household financial management services. These income generation activities have been piloted over the last year and include small animal husbandry (chicken and goats), cash crop production (passion fruits), and craft production (baskets). Additional activities will include training in agricultural sustainability, small business management, and personal finance. Through a non-profit social investment in poverty reduction, SHIP will use proceeds from an external revenue source to provide PLWA skills and materials and to start meaningful business ventures that will increase household income generation and positively impact the economic status of our clients.
SHIP will train the next generation of public health leaders in rural Uganda and strengthen the academic mission of MUST through entrepreneurship business clinics. Because SHIP’s mission is to invest in public health at the household level and developing the next generation of public health leaders through strengthening the academic mission of MUST, SHIP is non-profit and will invest all proceeds toward achieving these goals.
Sustainable Household Income Project has been on going since 2009 to date.
20 participants have been consented and recruitment into the SHIP Study, 4 are males and 16 females. 11 participants are HIV positive and 9 are HIV negative. The 11 HIV positive participants have been generating income and recently completed their 6 month follow up visits. The 9 HIV negative participants were recently enrolled into the study and will begin training in March-April 2012.
Recruitment of study participants has been quite slow mainly because the first phase started with pilot preparation of the lemon grass demonstration farm before study participants could be recruited unto the study of which when an economic evaluation was carried out on lemon grass project, it was found not viable so the project has embarked on other income generating activities like Chicken Coop. As of the time of this writing, no data analysis has been performed.
During the course of implementing this study we experienced a minor protocol deviation related to holding a community sensitization meeting where some of the people who attended the community meeting were not eligible for participation in the SHIP study. We reported the issue to the Mbarara University of Science and Technology Institutional Review Committee and Uganda National Council of Science and Technology. As a result we applied for a minor modification to include community meetings as a recruitment method and expanding eligibility to include individuals who are not concurrently enrolled in UARTO. Data analysis has not yet been done.