1. Theresa Banda

2. VI Operational Research Advocacy Technical support VN Production and marketing RUF Introduction

3. Research

4. Follow up component- SC USA data collection, analysis and report completed Detailed analysis for identification, write up and publication of papers is on going CSA ( Chronically Sick Adults )

5. PREWAS(Prevention of Wasting) Prevention of Weight Loss in People Living with HIV/AIDS PLWHAs (PREWAS) Implementers – Valid, MACRO, MoH Study sites – MACRO structure- LL, Mzuzu, (2008) Government Rural hospital structure Mitundu (2009)

6. OBJECTIVE Identify a nutrition intervention that would prevent wasting in PLWHAs in WHO stages 1 and 2 with CD4 Count >250

7. TARGET GROUP WHO Stage 1 or 2 with CD4 count >250 Well nourished and good health (no diabetes, hypertension, kidney) Age 18 – 59, not on ART Discharge criteria Meets ART initiation criteria Has developed stage 3 or 4 condition defining

8. Progress of study Slow progress – 288 out of required 300 recruited into the study Phased out recruitment in MACRO sites- follow ups only. Recruitment continues in Mitundu Monthly follow-ups are a challenge in MACRO sites (urban areas)

9. Observations Only 50 % of the clients collect CD4 count results 50% of clients in WHO Stages 1 and 2 have CD4 count >250 cells/ml CD4 count results are declining regardless of nutritional status or history of illness Follow-up of clients is challenging- preventive vs Curative culture, fear to be known, occupation-small business

10. SUB STUDIES BIO-ELECTRICAL IMPEDANCE ANALYSIS (BIA) Is detailed assessment of body composition and cell condition using Bodystat® 1500MDD machine Identifies malnutrition before weight, MUAC and BMI decrease

11. BIA Variables of interest : Fat (weight, percentage, mass index), Fat free (wt, mass index), Phase angle (measure of cell integrity), Wellness marker Body mass index (BMI)

12. BIA Status Normal distribution determination exercise completed, Offered to everyone regardless of HIV sero-status Those in study offered BIA on Admission Every 6 th month (when due for CD4 count recheck) When there is a disease episode After disease episode

13. Uptake of PLWHA into Positive Living Groups To determine coverage and factors that influence uptake of PLWHA into Positive living groups Background High prevalence of HIV, High HCT uptake, Many positive living groups in the district Status Data collection, entry, cleaning completed Started analysis, slow, qualitative research, little expertise within Valid at country level

14. Whey Protein RUTF(WPC34) Development, acceptability and effectiveness trial of milk whey protein based Ready-To-Use Therapeutic Food in treatment of severe acute malnutrition in under-five children.Collaborators – Valid (VI & VN) MOE, MoH, CF funding from USDEC Study sites – Lilongwe District (schools and OTP sites Production of RUTF Kenya and Malawi

15. Whey Protein RUTF(WPC34) Status  Recipe Development and Production test completed  Acceptability trial in progress and Effectiveness trial planned to start January 2010  Overall impression, school age children like the product- most of them complete 250g within a short time (break times at school) Observation  Challenges in sourcing Whey Protein

16. Advocacy

17. Advocacy Activities Nutrition as Central in Development  Importance of good nutrition through government structure- Nutrition committee, Technical working groups, specific events  Coordination of nutrition in the country  Resource mobilization within the government structure (OPC and MOH)

18. Advocacy Activities CTC  As member of CAS (CTC Advisory Service)  Through TWGs on management of malnutrition, infant and young child nutrition, Nutrition care and support for PLWHA, Research  Special events- American Embassy health functions, National celebrations HIV interventions- VI member of Health sector response to HIV

19. TechnicalSupport

20. Technical Support Has reduced over time after formulation of CAS and impressions that VI is expensive TA provided to organizations : scaling up CTC within districts- MOH and CHAM Nutrition care and support for PLWHA- Action AID and Private hospitals OPC, MOH in nutrition research, monitoring activities

21. RUFProductionandMarketing

22. RUF Production and Marketing Production facility- certified by UNICEF for local supply and awaiting global certification scheduled for January VI promotes RUF products for the following: CTC, management of adolescent and adults malnutrition, school feeding, research e.g Major supplier of RUTF in CTC programs RUSF accepted to be used in school feeding to start on pilot- awaiting funding RUSF planned to be used in growth faltering

23. THANK YOU