STEP Story: Jill Hagey

4th Year Medical Student, University of California, San Francisco (UCSF)
Kisumu, August 2016

Jill HageyFood insecurity and HIV/AIDS remain two of the main causes of mortality and morbidity in Kenya, and are intertwined in a vicious cycle where one predisposes to the other. Over 70% of people living with HIV in Kenya and Uganda are moderately or severely food insecure, as most individuals affected by the virus are working-aged individuals that can no longer participate in income-generating activities to either make or buy their own food. Additionally, food insecurity is associated with declining physical health status, decreased viral suppression, lack of adherence to ART, and decreased clinic visits as clients try to secure food as opposed to coming to the clinic.

This cycle is being studied by Shamba Maisha (“Farm Life” in Dholuo, the local language in Western Kenya), a large randomized control trial being implemented throughout three counties in Western Kenya – Kisumu, Homa Bay, and Migori. The study hopes that by providing HIV-positive farmers with a microfinance loan, a water pump, and agricultural training that they will not only have improvements in their nutritional and food security status, but also in their HIV disease.

However, tracking data for this study remains quite challenging. As the study is a collaboration across clinicians, agricultural scientists, nutritionists, behavioral scientists, and child growth and development specialists, the amount of data being collected from each participant is enormous. Indeed, the enrollment visits for these clients can take two to three hours, and often involve a stopping point for biscuits and a soda about halfway through the interview. And that’s where I came into the study.

While in Kenya, I’ve been combing through the data collected through the study, and helping ensure its validity. Most days, that means checking with the Ministry of Health “Blue Cards” in each HIV positive patient’s file, verifying the latest viral load or ART regimen. However, it has also meant understanding how different questions are interpreted when they have been translated into Dholuo from English – like the differences between “clan” and “family” in Dholuo when talking about disclosure of one’s HIV status, or that the “Screening Identification Number” and “Participant Identification Number” translate to the same phrase in Dholuo, causing challenges in tracking patient identities in the study. Additionally, using new technologies like the MEMS (Medication Event Monitoring System) caps to track adherence among the participants has come with their own set of challenges.

My work in country has been a great opportunity to see how data is being collected on the ground so I can inform how the data is viewed and analyzed back in the United States, but the work hardly ends here. With 12 additional clinics being added to the study in the next six months, by the time I’m back again in Kenya the study will be in full swing and there will be variations in data collection between the different sites and research assistants. I’m looking forward to the challenge ahead, and looking forward to being able to use all this data to understand the complex relationship between HIV and food security.