1. Integrating Nutrition Security into AIDS Care & treatment By Dr Christine Nabiryo

2. Presentation outline  TASO Background  TASO services  Integration of Nutrition into care  Sustainable livelihoods  Opportunities- WFP, Title II, RENEWAL  Way Forward

3. TASO Background  Started in 1987 by Noerine Kaleeba and 16 Others  Mission: ‘Exists to preventing HIV/AIDS & contributing to the process of restoring hope and improving the quality of life of people, families & communities infected and affected by HIV/AIDS disease  Headquarters at Mulago, 4 regional offices and 11 centers

4. Services offered 1  Counselling: positive living, prevention and adherence Testing: At registration, during recruitment onto ART, during home based HIV counselling and testing (HBHCT). Testing: At registration, during recruitment onto ART, during home based HIV counselling and testing (HBHCT). Sensitization: drama group performances and health talks Sensitization: drama group performances and health talks  Medical: diagnosis and management of opportunistic infections and STDs.  Basic care package-septrin prophylaxis, safe water vessels, waterguard, +/- condoms and bed nets

5. Cumulative clientele over 158,380 Cumulative clientele over 158,380 Active clients 80,000 PLWAs Active clients 80,000 PLWAs Recruitments onto ART-15900 clients Recruitments onto ART-15900 clients Family members tested for HIV over 20,250 Family members tested for HIV over 20,250 Food support -28,897 (WFP) and 35,043(ACDI-VOCA) Food support -28,897 (WFP) and 35,043(ACDI-VOCA)

6. Services offered 2  HIV prevention: PMTCT+, HBHCT  ART: Adult and pediatric Adult and pediatric home and facility based monitoring, home and facility based monitoring, Social support: tuition, scholastic materials, apprenticeships and food Social support: tuition, scholastic materials, apprenticeships and food Training: counselling, medical management of HIV/AIDS Training: counselling, medical management of HIV/AIDS

7. TASO- WFP collaboration Model  12 months food supplementation of family diets, 1293 Kcal/day for 7 family members  Food basket includes – Cereals, Corn Soy Blend, vegetable oil & pulses  Targets clients – TB, ART, PMTCT and OVCs  Eligibility criteria used to identify beneficiaries  Food distribution at 7 centers to 7374 clients

8. TASO - WFP collaboration Model  Exit strategy plan communication at beginning of food support  Beneficiary reassessment before exit

9. 6 months Food program impact assessment, 2005 1200 sample clients followed over 12 months  49% of beneficiaries 3 kgs weight gain or more  20% 2 kgs gain  25% no change in weight  6% lost weight

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12. Moving Up: A Holistic Approach LOANS and SAVINGS FOOD AID Sustainable Livelihoods programming

17. Family support system  For the success of SLP, family support has been encouraged. Clients are encouraged to involve their children and other family members in all the activities they do. This enhances sustainability in family projects and support especially when the client is weak.

18. Family support

20. Demonstration garden at the center

21. Challenges  High demand for food by clients  Inability to wean off some clients due to ill health  Some clients fail to collect food due to transport costs  Mobilizing resources & networks for complimentary sustainable livelihoods programming  Food insecurity / Underlying Poverty

22. Gaps  Nutrition surveillance & reference values for PLWAs  Nutrition & HIV/AIDS research agenda  Capacity & Resources for nutrition & HIV programming  Referral system for Sustainable livelihoods programming beyond project support

23. Opportunities – WFP, Title II, RENEWAL  WFP & Title II - Short term food aid, efforts in Sustainable livelihoods programming  RENEWAL research collaboration - food security and HIV programming at TASO

24. Proposed Research Studies  Short term (1 year) Secondary data analysis of TASO data Secondary data analysis of TASO data  Medium term (2 years) Retrospective evaluation and cost-benefit analysis of TASO’s sustainable livelihood programs (SLP) Retrospective evaluation and cost-benefit analysis of TASO’s sustainable livelihood programs (SLP) Cost –benefit analysis of nutrition supplementation Cost –benefit analysis of nutrition supplementation PLWH and household level analysesPLWH and household level analyses

25.  Long-term Surveillance of HIV-positive population with a focus on food and nutrition security Surveillance of HIV-positive population with a focus on food and nutrition security A prospective cohortA prospective cohort

26. Way Forward  Mainstreaming food security into short term Nutrition support  Establishing linkages & partnership for Nutrition security  Client empowerment towards Nutrition security  Research partnerships – Recommendations to Policy

27. Way Forward at TASO  Advocacy for increased focus on HIV/AIDS & nutrition  Sustainable livelihoods programming  Nutrition program evaluation – tracking body composition, clinical and immunological indices  Strengthening nutritional surveillance & research

28. Acknowledgement  Clients  TASO team  WFP team  RENEWAL- Uganda National Advisory team & Regional Team  IFPRI

29.  Thank you