1. Ensuring food and nutrition security
Ensuring food and nutrition security in the time of AIDS in Kenya Margaret Akinyi Wagah

2. RENEWAL Kenya objectives
To reduce critical gaps in understanding
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

3. Core pillars/processes of RENEWAL
Action research
Communications
Capacity

4. AMPATH, Moi University, IFPRI
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

5. Background 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

6. Why nutrition?
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.

7. Nutrition intervention cont…
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
Patients sell to farm
Buy from area markets
Program also provides nutrition education and counseling to patients and caregivers;
Agricultural skills training

8. Nutrition intervention cont..
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

9. Eligibility criteria for supplements
Identifying patients:
Advanced disease, CD4 <200
BMI <18
Unable to meet their food requirements
Flexibility
Food prescription:
Written by the patient’s clinic nutritionist
Food support is for patient and approved household members

10. Study rationale Need to understand: In order…
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
In order…
To construct formal support networks which will enhance and complement (rather than supplant) functioning informal support networks.

11. Very preliminary impressions
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.

12. 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.

13. RENEWAL National Roundtable
Nairobi, 22 February 2006

14. Selected research priorities
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?

15. Capacity strengthening and communications
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!

16. ASANTE!!!