Action Against Hunger, 247 West 37th Street, New York, NY 10018, USA.
Action contre la Faim - France, 4 rue Niepce, 75 662 Paris Cedex 14, France.
Cost Eff Resour Alloc. 2014 Apr 30;12:11. doi: 10.1186/1478-7547-12-11. eCollection 2014.
There is little evidence to date of the potential impact of vegetable gardens on people living with HIV (PLHIV), who often suffer from social and economic losses due to the disease. From 2008 through 2011, Action Contre la Faim France (ACF) implemented a project in Chipinge District, eastern Zimbabwe, providing low-input vegetable gardens (LIGs) to households of PLHIV. Program partners included Médecins du Monde, which provided medical support, and Zimbabwe's Agricultural Extension Service, which supported vegetable cultivation. A survey conducted at the end of the program found LIG participants to have higher Food Consumption Scores (FCS) and Household Dietary Diversity Scores (HDDS) relative to comparator households of PLHIV receiving other support programs. This study assessed the incremental cost-effectiveness of LIGs to improve FCS and HDDS of PLHIV compared to other support programs.
This analysis used an activity-based cost model, and combined ACF accounting data with estimates of partner and beneficiary costs derived using an ingredients approach to build an estimate of total program resource use. A societal perspective was adopted to encompass costs to beneficiary households, including their opportunity costs and an estimate of their income earned from vegetable sales. Qualitative methods were used to assess program benefits to beneficiary households. Effectiveness data was taken from a previously-conducted survey.
Providing LIGs to PLHIV cost an additional 8,299 EUR per household with adequate FCS and 12,456 EUR per household with HDDS in the upper tertile, relative to comparator households of PLHIV receiving other support programs. Beneficiaries cited multiple tangible and intangible benefits from LIGs, and over 80% of gardens observed were still functioning more than one year after the program had finished.
Cost outcomes were 20-30 times Zimbabwe's per capita GDP, and unlikely to be affordable within government services. This analysis concludes that LIGs are not cost-effective or affordable relative to other interventions for improving health and nutrition status of PLHIV. Nonetheless, given the myriad benefits acquired by participant households, such programs hold important potential to improve quality of life and reduce stigma against PLHIV.
目前几乎没有证据表明菜园可能对艾滋病毒感染者（PLHIV）产生影响，这些人经常因疾病而遭受社会和经济损失。2008 年至 2011 年期间，法国行动援助组织（ACF）在津巴布韦东部奇平格区实施了一个项目，为 PLHIV 的家庭提供低投入菜园（LIG）。项目合作伙伴包括提供医疗支持的无国界医生组织（Médecins du Monde）和支持蔬菜种植的津巴布韦农业推广服务处。在项目结束时进行的一项调查发现，与接受其他支持项目的 PLHIV 对照组家庭相比，LIG 参与者的食品消费评分（FCS）和家庭饮食多样性评分（HDDS）更高。本研究评估了与其他支持项目相比，LIG 对改善 PLHIV 的 FCS 和 HDDS 的增量成本效益。
本分析使用基于活动的成本模型，结合 ACF 会计数据和使用成分法估算合作伙伴和受益人的成本，构建了项目资源总使用量的估算。采用社会视角来涵盖受益人家户的成本，包括他们的机会成本和从蔬菜销售中获得的收入估算。采用定性方法评估了方案对受益人家户的效益。有效性数据取自先前进行的一项调查。
与接受其他支持项目的 PLHIV 对照组家庭相比，为 PLHIV 提供 LIG 的成本，每个家庭的 FCS 达到适当水平增加了 8299 欧元，HDDS 达到上三分位数增加了 12456 欧元。受益人称从 LIG 中获得了多种有形和无形的收益，超过 80%的菜园在项目结束一年后仍在运作。
成本结果是津巴布韦人均 GDP 的 20-30 倍，不太可能在政府服务范围内负担得起。本分析得出的结论是，与其他改善 PLHIV 健康和营养状况的干预措施相比，LIG 既不具有成本效益，也不可负担。尽管如此，考虑到参与家庭获得的众多收益，此类项目具有改善生活质量和减少对 PLHIV 污名化的重要潜力。
