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Programming Experiences and Challenges

Programming Experiences and Challenges. Cade Fields-Gardner, MS, RD, LDN, CD TCE Consulting Group. HIV-Specific Programming. Considerations: The usual: general food insecurity, disease HIV uniqueness: medical, social Goals: Medical, social, economic

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Programming Experiences and Challenges

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  1. Programming Experiences and Challenges Cade Fields-Gardner, MS, RD, LDN, CD TCE Consulting Group

  2. HIV-Specific Programming • Considerations: • The usual: general food insecurity, disease • HIV uniqueness: medical, social • Goals: • Medical, social, economic • Context-dependent: range of target populations, available services, baseline conditions and issues

  3. Nutrition/Food-Related Needs • HIV vs HIV + risk factors • Lessons from infection • Different risk factors and changes in nutrient needs • Increases and decreases (needs and tolerances) • Complications • Unique and common

  4. Examples • Food by Prescription • Incentive to access medical care • Medical nutrition intervention • Food security • HIV-infected as criteria for vulnerability • HIV-affected as criteria for vulnerability

  5. HIV-Specific Examples • Creating categories and training • Malnourished vs adequate by what criteria? • CD4+ - does it count for nutrition? • Previous weight loss, significant decline in BMI • What measures are associated real clinical benefit? • What benefits can be achieved? • Is gaining weight quickly the best thing to do? • Is restoration the same as baseline?

  6. Practice and Evidence? • What lessons can we take from developed countries? • Related to HIV • Transferred from other conditions • Macro- vs micro-modulation: priorities! • What difference are needed in resource-limited settings? • Considering additional criteria: social, economic in a single program • Doing something vs waiting for evidence

  7. Field Experiences • HIV-related distribution in pilot programs and as a part of PVO distribution programs • Isolated soy protein beverage supplemental nutrition for patients in Cape Town, RSA improved consumption of high quality protein • Micronutrient-fortified dehydrated potato flakes in Zambia to improve micronutrient consumption • Nutrition rehabilitation with potato flakes in Burkina Faso food basket: possible additive effect for rehabilitation

  8. Summary • HIV is chronic, inflammatory disease with very individual risk-factors, complications, and intervention needs • Programming nutrition is challenging in current program settings with resource limitations • Experience from pilot and project information needs to be standardized to contribute to knowledge base • Experience can draw from general programs to be tested in HIV intervention settings

  9. Summary • Pilots and plans for adjustment and scale up could be included in existing and proposed programs • Private-public partnerships can bring innovation and technical expertise • Recommendations and requirements for may be more reasonably adopted if the reasoning is based on measurable results • If micro-modulatory recommendations are to be made, there is a need to show value in this context

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