RENEWAL Kenya objectives

1. Ensuring food and nutrition security in the time of AIDS in KenyaMargaret 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. Action research Capacity Communications Core pillars/processes of RENEWAL

4. 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: • 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!!!