Perceptions and impact of a multisectoral nutrition-sensitive agricultural program among people living with HIV in Senegal, West Africa: A pilot study.

Food insecurity is highly prevalent among people living with HIV (PLHIV) in Senegal and is associated with poor HIV outcomes. Multisectoral nutrition-sensitive agricultural (MNSA) programs may address interconnected drivers of poor HIV outcomes, but evidence is limited, particularly in West Africa. This pilot study evaluated the perceptions and impact of a MNSA program implemented in Senegal. We conducted a convergent mixed methods study among adults ≥18 years of age, living with HIV and receiving ART in Ziguinchor, Senegal. For the quantitative strand, data from MNSA program participants and historical controls were compared. Quantitative measures included the Household Food Insecurity Access Scale (HFIAS), Body Mass Index (BMI), CD4 cell count, and HIV viral load. Group differences were assessed using Chi-square and Mann-Whitney U tests, and logistic regression was used to examine associations with viral suppression. For the qualitative strand, semi-structured interviews were conducted with MNSA program participants. Qualitative data were analyzed thematically. Data from 56 program participants and 59 controls were included. Viral suppression (<1000 copies/mL) was significantly higher among MNSA participants than controls (94.2% versus 77.8%, p = 0.02). Participants had higher median BMI (24.8 versus 21.7, p < 0.01) and lower prevalence of underweight. Moderate-to-severe food insecurity was lower among program participants, though differences were not statistically significant. Logistic regression showed a trend towards an association between MNSA program participation and viral suppression (OR 3.84; 95% CI 0.97-15.13). Qualitative interviews revealed five major themes: greater autonomy and empowerment, improved mental health, strengthened social cohesion, improved household nutrition and financial stability, and enhanced ART adherence. Findings from this pilot study suggest that the MNSA program is acceptable and may be associated with improvements in viral suppression, nutritional status, food security, and psychosocial well-being among PLHIV. Future studies using a randomized controlled approach are needed to further evaluate impacts, explore mechanisms, and assess potential for scalability.