Transcript Impact of Nutrition Program for AIDS patients and its role

Ensuring food and nutrition security
in the time of AIDS in Kenya
Margaret Akinyi Wagah
RENEWAL Kenya objectives
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To reduce critical gaps in understanding
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how livelihoods contribute to the further
spread of HIV in Kenya;
the impact of HIV and AIDS on livelihoods,
and ultimately on food and nutrition security
in Kenya;
To generate new policy-relevant
knowledge on how households and
communities may strengthen both their
resistance to HIV transmission and their
resilience to the impacts of AIDS
Core pillars/processes of RENEWAL
Action research
Capacity
Communications
Research Case Study:
Impact of a Nutrition Intervention for
People Living with HIV in Kenya, and its
Role in their Support Networks
AMPATH, Moi University, IFPRI
Background
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AMPATH started in 2000,
First patients for provision of free ART and care
20,000 patients now enrolled, 9,700 on ARVs
To increase to 38,000 patients by end 2006
12 satellite clinics in western Kenya
Why nutrition?
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Female patients in the initial treatment cohort were often
widowed, undernourished, with no food in their homes,
and small children at home
Patients were not responding well to treatment alone
Nutrition intervention i.e. the Haart and Harvest Initiative
(HHI) was developed in 2002, and was incorporated into
the program as part of clinical care to complement ART
HHI has 4 farms used for food production, training,
demonstration, distribution to HIV+ clients
Provides locally acceptable and nutritionist-prescribed
food baskets NOT only for the registered patients on ART
but equally for the malnourished and the food insecure
households in the catchments area.
Nutrition intervention cont…
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Amount of food prescribed by the nutritionist is based on
household size.
Foods produced include: vegetables, fruits, eggs, milk
products, chicken, and occasionally beef
Since the food produced is not sufficient, the program
purchases other foods to meet additional needs
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Patients sell to farm
Buy from area markets
Program also provides nutrition education and counseling to
patients and caregivers;
Agricultural skills training
Nutrition intervention cont..
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WFP started supporting AMPATH program in mid-2005,
providing food supplements to meet 50% RDA for 2200
mouths.
Food basket comprises maize, pulses, oil, and CSB to
under-fives and pregnant or lactating women.
Targets new ART patients meeting criteria
Patients on food program for 6 months, then “weaned”
In Jan. 2006, scale-up to 15,000 mouths
USAID also started supporting program from January
2006 though provision of Instamix (maize-soy blend) to
index patients
Eligibility criteria for supplements
 Identifying
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Advanced disease, CD4 <200
BMI <18
Unable to meet their food requirements
 Flexibility
 Food
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patients:
prescription:
Written by the patient’s clinic nutritionist
Food support is for patient and approved household
members
Study rationale
 Need
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Impact of ART and nutritional support on mitigating
health and economic impacts of HIV on patient,
household, and community,
How nutritional support programs influence informal
support networks,
Interactions between formal and informal support
networks, and
Effectiveness, sustainability and scalability
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to understand:
order…
To construct formal support networks which will
enhance and complement (rather than supplant)
functioning informal support networks.
Very preliminary impressions
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A range of Social support networks is enabling dietary
diversity, towards a “more balanced diet”.
• Reverse trends in food Consumption patterns in HIV
households…potential impact of food transfers
• Intervention is a catalyst for additional support from
family and community via visible health improvements
• Financial resources reallocated to other household
needs
• Improvements in labour supply 6 months after treatment
initiation are estimates of impact of treatment.
Gaps and challenges
‘Weaning’ needs more thought
Stigma still an obstacle to HIV+ individuals accessing
formal and informal support (eg the AMPATH milk
packet with red ribbon)
 Animal source foods not as easily replaced for families
without livestock, post-intervention
 Sustainability of formal food supplementation program
 Implementation still an evolving process, transparency
and communication are important
 Need to refine and clearly define eligibility criteria, and
harmonize between HHI, WFP and USAID.
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RENEWAL National Roundtable
Nairobi, 22 February 2006
Selected research priorities
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Link household food security research with individual-level
clinical research on nutrition and AIDS
Impact of stigma on food and nutrition security?
Impact of AIDS on productivity of women?
Adapting guidelines….operational research on the realities and
constraints
Implications of home-based care for other family members?
What is complete HBC package?
Cost-effectiveness and sustainability of different interventions
Operations research (including M&E), develop quantifiable
indicators to measure impact of mainstreamed programmes
Look into how development programs affect HIV incidence?
How does mobility and migration affect HIV spread in Kenya
including cross-border?
Capacity strengthening and communications
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Develop capacity assessment protocol to reveal gaps.
Strengthen capacity of policymakers to better legislate on
AIDS, food and nutrition-relevant issues
Develop capacity for good M&E
Develop long-term program e.g. postgraduate university
programs linking with RENEWAL
Advocacy for operationalizing guidelines
Need to explode some myths (policy brief, letter to Lancet)
Sift out the anecdotes. Evidence-based communications
How to capture all research underway (mapping of
research, dissemination) and improve multisectoral
collaboration and communication (who is doing what,
where?)
Don’t reinvent wheels!
ASANTE!!!