This document discusses integrating nutrition into national HIV policies and programs based on experience from Africa. It summarizes the scientific evidence showing that nutritional supplementation can improve energy and protein intake as well as body weight and composition in HIV-positive individuals. However, more research is still needed to determine the impact on clinical outcomes like CD4 count and mortality. It also describes challenges faced and lessons learned from programmatic experiences integrating nutrition services into HIV care in several African countries. Key research gaps are identified around determining the effectiveness and cost-effectiveness of different food products and better harmonizing food security and nutrition programs for HIV-positive populations.
paediatric Nutrition in kapkatet district hospitalcheruiyot sambu
kapkatet district hospital is one of the best in the country (kenya) and it is situated in kericho county. paediatrict nutrition team is lead by sambu cheruiyot with MSCN, BSCN and BCN.
ACTIVE TB CASE FINDINGS IN SCHOOLS. CONDUCTED BY CHERUIYOT SAMBU AND COLLINS ...cheruiyot sambu
WE CONDUCTED PROSPECTIVE STUDY IN TENGECHA BOYS HIGH SCHOOL IN KERICHO COUNTY. FROM THE FINDINGS THERE IS A NEED TO SCREEN FOR TB IN ALL BOARDING SCHOOLS AND VENTILATION IN CLASSES AND LIVING ROOMS IS NECESSARY. WE PRESENTED IN CONFERENCE ORGANISED BY KAPTLD ON 18 TO 22 NOVEMBER 2015 IN TRAVELLERS BEACH HOTEL MOMBASA.
Delivered by Dr. Paul Seale, Family Physician and Professor & Director of Research in the Dept. of Family Medicine Navicent Health/Mercer University, this presentation shows the potential Georgia has for being a leader implementing SBIRT.
Factors Associated with Growth in the First 1,000 Days CHECKLEYCORE Group
CORE Group GHPC15
October 8, 2015
Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition
paediatric Nutrition in kapkatet district hospitalcheruiyot sambu
kapkatet district hospital is one of the best in the country (kenya) and it is situated in kericho county. paediatrict nutrition team is lead by sambu cheruiyot with MSCN, BSCN and BCN.
ACTIVE TB CASE FINDINGS IN SCHOOLS. CONDUCTED BY CHERUIYOT SAMBU AND COLLINS ...cheruiyot sambu
WE CONDUCTED PROSPECTIVE STUDY IN TENGECHA BOYS HIGH SCHOOL IN KERICHO COUNTY. FROM THE FINDINGS THERE IS A NEED TO SCREEN FOR TB IN ALL BOARDING SCHOOLS AND VENTILATION IN CLASSES AND LIVING ROOMS IS NECESSARY. WE PRESENTED IN CONFERENCE ORGANISED BY KAPTLD ON 18 TO 22 NOVEMBER 2015 IN TRAVELLERS BEACH HOTEL MOMBASA.
Delivered by Dr. Paul Seale, Family Physician and Professor & Director of Research in the Dept. of Family Medicine Navicent Health/Mercer University, this presentation shows the potential Georgia has for being a leader implementing SBIRT.
Factors Associated with Growth in the First 1,000 Days CHECKLEYCORE Group
CORE Group GHPC15
October 8, 2015
Concurrent Session: Factors Associated with Growth in the First 1,000 Days: Translating Evidence into Programs for Stunting, Wasting, and the Double Burden of Malnutrition
Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis
M.A.P. Barbosa, D. M. Teixeira, P.A.A.S. Navarro, R.A. Ferriani, C. O. Nastri, W. P. Martins
Volume 44, Issue 3, Date: September 2014, Pages 261-278
http://onlinelibrary.wiley.com/doi/10.1002/uog.13366/abstract
Science Forum 2013 (www.scienceforum13.org)
Plenary session: Evaluating nutrition and health outcomes of agriculture
Shibani Ghosh, Tufts University: case study presentation
Sex, Drugs & Scotland's Health- Healthcare use among people living with HIV i...HIVScotland
Delivered at Sex, Drugs & Scotland's Health Virtual Conference, this presentation was delivered by Alastair Hudson.
More information about the virtual event is available here: http://ow.ly/YntW50GWhJ0
Difficult to choose topic for your nursing capstone? Check this list of best nursing capstone paper topics for your project. https://www.capstoneproject.net/best-capstone-project-ideas/
palliative care presented by sambu cheruiyot clinical nutritionist in kapkate...cheruiyot sambu
currently we need to understand the role of palliative care in our patients. kapkatet hospital have strongly participated in provision of palliative services. come and witness the strong team willing to help the community.
Programs to improve infant and young child nutrition in the context of HIVRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Rene Ekpini
Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis
M.A.P. Barbosa, D. M. Teixeira, P.A.A.S. Navarro, R.A. Ferriani, C. O. Nastri, W. P. Martins
Volume 44, Issue 3, Date: September 2014, Pages 261-278
http://onlinelibrary.wiley.com/doi/10.1002/uog.13366/abstract
Science Forum 2013 (www.scienceforum13.org)
Plenary session: Evaluating nutrition and health outcomes of agriculture
Shibani Ghosh, Tufts University: case study presentation
Sex, Drugs & Scotland's Health- Healthcare use among people living with HIV i...HIVScotland
Delivered at Sex, Drugs & Scotland's Health Virtual Conference, this presentation was delivered by Alastair Hudson.
More information about the virtual event is available here: http://ow.ly/YntW50GWhJ0
Difficult to choose topic for your nursing capstone? Check this list of best nursing capstone paper topics for your project. https://www.capstoneproject.net/best-capstone-project-ideas/
palliative care presented by sambu cheruiyot clinical nutritionist in kapkate...cheruiyot sambu
currently we need to understand the role of palliative care in our patients. kapkatet hospital have strongly participated in provision of palliative services. come and witness the strong team willing to help the community.
Programs to improve infant and young child nutrition in the context of HIVRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Rene Ekpini
Improving maternal nutrition: A review of evidence on the one-full meal programPOSHAN
Presentation made at a virtual event on “Improving maternal nutrition: A review of evidence on the One-Full Meal program” which was co-hosted by the ICMR-National Institute of Nutrition (NIN), Hyderabad, Institute of Economic Growth (IEG), International Food Policy Research Institute (IFPRI), and UNICEF, on 31 March 2020.
Conditional Cash Transfer Programs and Nutrition in Latin America: Assessment...FAO
Presentación de John Hoddinott and Lucy Bassett, International Food Policy Research Institute IFPRI, durante el Tercer Seminario de Transferencias Condicionadas de Ingresos, realizado en Santiago de Chile el 01 y 02 de Diciembre de 2008.
Evidence-based guidelines for the nutritional management of adult oncology pa...milfamln
Webinar Objectives
1. The participant will be able to discuss the validity of malnutrition screening and nutrition assessment tools and their utilization in clinical oncology settings
2. The participant will be able to better utilize the Nutrition Care Process to provide appropriate and high-quality nutrition care to oncology patients
3. The participant will be able to describe the evidencebased relationships between nutritional status and morbidity and mortality outcomes in oncology
TESTING A READY-TO–USE–SUPPLEMENTARY-FOOD (RUSF) OF HIGHER PROTEIN QUALITY ON...Adetutu Sadiq
My Final Symposium Presentation for the Summer Research Program I was a part of at Washington University in St. Louis, MO.
I worked in Child malnutrition in Malawi.
Harold Alderman
REGIONAL WORKSHOP
SPIR II Learning Event
Co-organized by IFPRI, USAID, CARE, ORDA, and World Vision
MAY 16, 2023 - 9:00AM TO MAY 17, 2023 - 5:00PM EAT
A project proposal for East Timor on improving health and nutrition for women...Kazuko Yoshizawa
The presentation outlines a project proposal aimed at capacity building in health and nutrition for Timor-Leste, developed through extensive consultation with the Ministry of Health, development partners, NGOs, and civil society. The primary objective of the project is to enhance the nutritional status of women and children who are particularly vulnerable to malnutrition. The project proposal comprises four key areas that address the capacity gaps identified through stakeholder consultations and documented in published reports and strategies. By providing additional support and interventions, as well as strengthening existing structures, the proposed interventions would help to improve the nutrition status of children and women. The proposal further suggests that the capacity of Integrated Community Health Services (Sisca) could be enhanced to improve rural health services. Such improvements would help to address the existing disparities in health outcomes between rural and urban areas in Timor-Leste. Through the proposed interventions, the project aims to support the overall development of the health and nutrition sector in Timor-Leste. By addressing the identified capacity gaps, the project would help to build sustainable systems that can deliver effective health and nutrition services to the population.
In conclusion, the presentation explains a comprehensive project proposal that aims to improve the nutritional status of vulnerable women and children in Timor-Leste. The proposal is based on extensive consultation with stakeholders and would address capacity gaps identified through published reports and strategies. Through this project, it would be possible to enhance rural health services by strengthening the capacity of Integrated Community Health Services (Sisca) and supporting existing structures. Ultimately, the proposed interventions would contribute to the development of sustainable health and nutrition systems in Timor-Leste.
Addressing HIV and nutrition linkages: from evidence to impactRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Scott Drimie
Social Protection for Children Affected by HIV & AIDS: Experiences from KenyaRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Jacqueline Oduol, presented by Margaret Wagah
Food and Nutrition Assistance Programs to HIV Infected and Affected IndividualsRENEWAL-IFPRI
Presented at RENEWAL’s Satellite Session "Nutrition Security, Social Protection and HIV: Operationalizing Evidence for Programs in Africa" at the XVIII International AIDS Conference. By Rahul Rawat
RENEWAL and JLICA: key findings from collaboration
Integrating nutrition into national HIV policies and programs: experience from eastern and southern Africa
1. Integrating nutrition into
national HIV policies and
programs:
Experience from Africa
Pamela Fergusson PhD
Nutrition and HIV Advisor FANTA-2
pfergusson@aed.org
Food and Nutrition Technical Assistance II Project (FANTA-2)
AED 1825 Connecticut Ave., NW Washington, DC 20009
Tel: 202-884-8000 Fax: 202-884-8432 E-mail: fanta2@aed.org Website: www.fanta-2.org
4. 2007 Cochrane review Eight trials (486 participants)
Significantly No effect
improved
Energy intake Body weight
Protein intake Fat-free mass
CD4 count
Small number of participants, no reporting of morbidity or
mortality, mostly resource-adequate setting
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004536. Nutritional interventions for
reducing morbidity and mortality in people with HIV. Mahlungulu S et al
5. Review: macronutrient supplementation for
HIV in resource constrained/adequate
settings
• BMI <16 = >2X RR of mortality (Malawi, Zambia, Tanzania)
• Resource constrained settings: 2 trials
Zambia: food insecurity entry, modest improvement in adherence, no
difference in weight gain, CD4 count or mortality
Malawi: FBF vs RUF
Increase in BMI and LBM after 3 months in RUF group
no significant differences in survival, viral load, CD4, or quality of life
At 3, 6, 9 months after food ended, no differences in any outcomes.
Clin Infect Dis. 2009 Sep 1;49(5):787-98. Macronutrient supplementation for malnourished HIV-infected
adults: a review of the evidence in resource-adequate and resource-constrained settings. Koethe
JR et al
J Acquir Immune Defic Syndr. 2008 Oct 1;49(2):190-5. A pilot study of food supplementation to improve
adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia. Cantrell RA et
al
BMJ. 2009 Supplementary feeding with either ready-to-use fortified spread or corn-soy blend in
wasted adults starting antiretroviral therapy in Malawi: randomised, investigator blinded,
controlled trial. Ndekha MJ et al.
7. Kenya KEMRI: FBF vs. No Food for HIV+
Adults
∆BMI (pre-ART N = 431 )
:
• Differences significant
through the 6th month.
• Food significant
determinant of ∆BMI at
3 and 6 months in
multivariate regression.
• Greater difference for
women than men.
• After 6 months
differences not
significant (n quite low
by then).
8. Kenya KEMRI: FBF vs. No Food for HIV+
Adults
∆BMI (ART N = 624)
• Differences significant
through the 3rd month.
• Food significant
determinant of ∆BMI at
3 months in multivariate
regression but not 6.
• Greater difference for
women than men.
• Rapid weight gain: 1.9
& 1.0 kg in 1st month
and 4.6 & 3.4 kg. by 3rd
month on food & non-
food respectively.
9. Kenya KEMRI: FBF vs. No Food for HIV+
Adults
Loss to Follow-up (pre-ART)
• Loss to follow-up a
huge problem in
Kenya.
• Among pre-ART
clients, LTF lower in
food group during
supplementation.
Difference not
significant for ART.
• Food is significant
independent predictor
of clinic attendance at
6 months among both
ART and pre-ART.
10. Implications from Studies
• RUF leads to faster weight/lean body mass
gain than CSB among adults on ART
• Impacts of food appear greater for pre-ART
than ART clients
• Improved adherence
• Impact of supplementation on CD4 and
mortality yet unproven
• Most benefits occur during the period of food
supplementation and may not persist beyond
12. Issues in quality of evidence
base
• Small sample size
• High loss to follow-up
• Ethics: comparing to a control group with no
supplementation
• Less evidence for interventions with PMTCT
and children/adolescents
• Few trials in African settings
• Little research evidence evaluating
programmatic approaches
13. Belief in the importance of
food Before and after ART
Although the evidence for
macronutrient
supplementation for PLHIV
remains weak, there is a
strong belief in the importance
of food and nutrition support
by PLHIV, staff at ART clinics.
“Clients were unanimous in
saying that “food rations
were a life saver.”
(GAIN working paper #2, FBP a Landscape Paper)
Why? Photo credit:
http://www.annielennoxsing.com/about-sing
15. NACS
Nutrition To clients who meet
criteria at sites
where available
Support .
Nutrition Counseling Periodically to
clients at all sites
Nutrition Assessment Routinely to all
clients at all sites
16. Integration of Nutrition into National
HIV Responses
• National Policy and Coordination
• Capacity Strengthening
• Service Delivery
• Information systems and evidence base
17. Challenges: managing service
provider time constraints
• Ghana 2010
assessment: nurses
report 6 min/patient
consultation
• Emphasis on strong
tools/job aids SBCC
• Sharing and
harmonising across
the region
appropriately
• Task shifting
18. Challenges: establishing national-
level coordination
• Establishing a nutrition and HIV technical
advisory group
• Ghana: Importance of membership of
group – coordination between HIV/medical
and nutrition stakeholders
• Ethiopia: Updating guidelines and policy –
working with gov’t and NGO stakeholders
19. Challenges: the importance of
quality improvement
• Training and materials are not sufficient
• Importance of harmonising indicators collected
and respecting staff time
• Kenya: good practice: electronic records
• Uganda: challenges: paper records means that
patients can be double or triple counted
• Namibia: multiple stakeholders creating M&E
systems, needs harmonisation
• Staff taking ownership of QI
21. Integrating with food security
programmes
Good practice
• Ghana: WFP exploring opportunities
working in harmony with FANTA-2 through
GHS: stakeholder consultation
• Namibia: MOHSS, FANTA-2 and LIFT
(AED) partnering to explore food security
& livelihoods opportunities in HIV
Issues
• Entry and exit criteria
• Overlap of target population
22. Challenges: facility-to-community
referral systems
• CMAM (child)
– Harmonising guidelines
– Multiple service delivery points
– Loss to follow-up (resources)
– HIV testing at community level
• Adult MUAC community based screening
– Opportunity to refer adults for testing and
follow-up
24. Research Gaps
• Effectiveness studies with large enough sample
size to report on mortality
• Relative effectiveness and cost-effectiveness of
various food products
• How to harmonize food security and nutrition
supplementation programs in HIV
• Further exploration of impact on quality of life:
qualitative research?
• More evaluation research into programmatic
approaches & sharing best practice