Action - Food by Prescription - Counselling on nutritional support&care for people living with HIV - Pregnant/lactating women with HIV/AIDS (PLWHA)

Programme: Food by Prescription

Programme description

 

For pre-antiretroviral treatment and antiretroviral treatment patients, clinical malnutrition is a risk factor for HIV and mortality. Malnutrition can also negatively impact birth outcomes among HIV-positive women. As HIV infection progresses, challenges to maintenance of adequate nutritional status—mal-absorption of nutrients, hyper-metabolism, etc.—increase and can adversely affect adherence to and effectiveness of drug treatments.

Food by Prescription provides food and nutritional support to malnourished HIV+ individuals in the form of therapeutic and supplementary feeding at health facility levels. The project serves severely malnourished people living with HIV/AIDS, HIV+ pregnant women, HIV+ women in their first six months post-partum, their infants, and orphans and vulnerable children. To ensure the program’s success, USAID works with the Ethiopian Ministry of Health and HIV/AIDS Prevention and Control Office, as well as the Food and Nutrition Technical Assistance (FANTA) project. Food by Prescription serves as a critical component of PEPFAR, a broader effort to strengthen integration of nutrition into HIV services. In order to reduce the cost associated with importation of nutrients and food commodities, the project will also collaborate with the public and private sector to explore the possibility of local production for some of the required food commodities.

Expected Results:

  • Provide nutritional assessment and counseling and Plumpy’nut to malnourished anti-retroviral treatment
  • Train at least five health providers and two pharmacists per facility
  • Mentors in facilities to assist in initiating the program and assisting in data recording
  • Establish strong partnership with university partners
  • Conduct Food by Prescription impact study

Programme type

Community/sub-national

References

Status: 
On-going

Start date:

January
2009

End date:

January
2013
Area: 
Urban
Rural
Peri-urban
Place: 
Addis Ababa, Amhara, Dire Dawa, Harari, Oromia, SNNP, and Tigray
Target group: 
Pregnant/lactating women with HIV/AIDS
Delivery: 
Hospital/clinic
Primary health care center
Implementation details : 

Two qualitative data collection rounds were included, with the following objectives:

a) Adherence and compliance: The objective of the first was to elaborate and contextualize the findings of the quantitative impact study, by exploring ration utilization and participant perceptions of the costs and benefits of participation in the FBP program. It sought to validate the assumption that participants were receiving and consuming the rations prescribed as per the program protocol and to identify the constraining factors and solutions for improved participant adherence. This component of the study also addressed issues of service provider participation, and the barriers and constraints to delivery that may have impacted the effects of the program on individuals.

b) Default and non-response: While the first qualitative study sought to identify constraints to adherence from a group of “successful” participants, a second study was designed to investigate the experience of “unsuccessful” participants, aiming to identify possible limitations to adherence among individuals who either defaulted from the program or failed to respond to the intervention.

The objective of the second qualitative study was to understand in greater depth the range of reasons for default among FBP program participants, as well as the range of reasons for poor weight gain among other participants.

The study was designed as a quasi-experimental effectiveness evaluation, with a comparison group of clinics selected from a  geographic area similar to those in  which the  intervention was being evaluated. Originally, the study was designed to reflect the existence of a  food support program being implemented by WFP in limited urban areas for households containing individuals with HIV. As the WFP program was providing a household ration to participant households, there was a concern that the measured impact of the FBP program could be biased by the presence or absence of the WFP program.

Therefore, the study sample was stratified to include three cohorts of participants who were followed longitudinally: two groups of adult PLHIV meeting FBP enrollment criteria in ART clinics at selected health facilities, one from  sites offering both the FBP program and the WFP program, and another from sites offering FBP only. Participants from these two groups were recruited for the study at the time when they enrolled in the FBP program. The third group, a comparison group, was composed of FBP-eligible adults recruited from FBP Phase II sites, i.e., where the program had not yet been rolled out but would do so during Year Two of the program.

However, after the FBP program and the impact study had commenced, the WFP program was phased out. Despite this, the three study groups were maintained, with the idea that the two treatment groups could be pooled eventually if the baseline characteristics of the two did not differ significantly.

Coverage level (%): 
A sample of 2059 program participants was recruited for the study treatment group, and 663 participants were recruited for the comparison group.
Outcome indicator(s): 
  • Change in body weight and body mass index
  • CD4 counts and a quality of life index
  • Survival/mortality rate
Baseline: 
BMI, ART status, MAM recovered, SAM recovered
Post-intervention: 

BMI, ART status, MAM recovered and SAM recoverd

Outcome reported by social determinants: 
Vulnerable groups

Revision log

DateUserLogState
Tue, 03/11/2014 - 17:28engesveenkEdited by william_nkoom.published
Wed, 03/27/2013 - 16:15bloessnermEdited by william_nkoom.published
Sun, 02/10/2013 - 17:00william_nkoomEdited by william_nkoom.draft
Sun, 02/10/2013 - 16:59william_nkoomEdited by william_nkoom.draft
Wed, 02/06/2013 - 01:12AnnaLarteyCreated by AnnaLartey.needs_review