A Scoping Review of Food Voucher Programmes and Gestational Weight Gain Among HIV-Positive Pregnant Women in Drought-Prone Regions of Madagascar

In drought-prone regions of Madagascar, food insecurity presents a critical public health challenge, particularly for pregnant women living with HIV. Suboptimal gestational weight gain (GWG) in this population is strongly linked to adverse maternal and neonatal outcomes. Food voucher programmes are a common nutritional intervention, yet their specific association with GWG among HIV-positive pregnant women in these vulnerable contexts is not well understood or synthesised. This scoping review aimed to map and synthesise existing literature on food voucher programmes and their measured association with GWG among pregnant women living with HIV in drought-affected areas of Madagascar. A scoping review was conducted following established methodological frameworks. A systematic search was performed across multiple electronic databases, and grey literature sources were also consulted. Studies of any design focusing on the relevant population and intervention were considered for inclusion. Data from selected studies were charted and analysed thematically. The search identified a limited number of studies directly addressing the review question. A prominent theme from the available evidence was the importance of programme design. Integrated programmes, which combined voucher provision with nutrition counselling and antenatal care, showed more consistent reports of adequate GWG compared to voucher provision alone. However, a significant gap in robust, comparative data quantifying the specific association was identified. There is a paucity of focused evidence measuring the association between food vouchers and GWG in this specific, high-risk population. While integrated service delivery models appear promising, the current literature is insufficient to draw definitive conclusions on the effectiveness of voucher programmes for optimising GWG in this context. Future primary research should employ robust longitudinal or comparative designs to quantify this association. Programme evaluations must consistently collect and report standardised maternal anthropometric data. Policy and practice should consider piloting integrated service delivery models while strengthening monitoring and evaluation frameworks to generate actionable evidence. scoping review, food vouchers, gestational weight gain, HIV, pregnancy, Madagascar, nutrition. This review clarifies the current evidence base and identifies a critical research gap regarding nutritional support for a highly vulnerable group, informing future research and programme design priorities in the field of maternal and child health in resource-limited, climate-affected settings.