Integrating Nutrition Integrating Nutrition Security into AIDS Security into AIDS Care & treatmentCare & treatment

ByBy

Dr Christine NabiryoDr Christine Nabiryo

Presentation outlinePresentation outline

TASO BackgroundTASO Background TASO servicesTASO services Integration of Nutrition into careIntegration of Nutrition into care Sustainable livelihoodsSustainable livelihoods Opportunities- WFP, Title II, RENEWALOpportunities- WFP, Title II, RENEWAL Way Forward Way Forward

TASO BackgroundTASO Background

Started in 1987 by Noerine Kaleeba and Started in 1987 by Noerine Kaleeba and 16 Others16 Others

Mission: ‘Exists to preventing HIV/AIDS Mission: ‘Exists to preventing HIV/AIDS & contributing to the process of restoring & contributing to the process of restoring hope and improving the quality of life of hope and improving the quality of life of people , families & communities infected people , families & communities infected and affected by HIV/AIDS diseaseand affected by HIV/AIDS disease

Headquarters at Mulago, 4 regional Headquarters at Mulago, 4 regional offices and 11 centersoffices and 11 centers

Services offered 1Services offered 1 Counselling: positive living, prevention Counselling: positive living, prevention

and adherenceand adherence Testing: At registration, during recruitment Testing: At registration, during recruitment

onto ART, during home based HIV onto ART, during home based HIV counselling and testing (HBHCT).counselling and testing (HBHCT).

Sensitization: drama group performances Sensitization: drama group performances and health talksand health talks

Medical: diagnosis and management of Medical: diagnosis and management of opportunistic infections and STDs.opportunistic infections and STDs.

Basic care package-septrin prophylaxis, Basic care package-septrin prophylaxis, safe water vessels, waterguard, +/-safe water vessels, waterguard, +/-condoms and bed netscondoms and bed nets

Cumulative clientele over 158,380Cumulative clientele over 158,380 Active clients 80,000 PLWAsActive clients 80,000 PLWAs Recruitments onto ART-15900 clientsRecruitments onto ART-15900 clients Family members tested for HIV over Family members tested for HIV over

20,25020,250 Food support -28,897 (WFP) and Food support -28,897 (WFP) and

35,043(ACDI-VOCA)35,043(ACDI-VOCA)

Services offered 2Services offered 2

HIV prevention: PMTCT+, HBHCTHIV prevention: PMTCT+, HBHCT ART: ART:

Adult and pediatricAdult and pediatric home and facility based monitoring, home and facility based monitoring, • Social support: tuition, scholastic Social support: tuition, scholastic

materials, apprenticeships and foodmaterials, apprenticeships and food• Training: counselling, medical Training: counselling, medical

management of HIV/AIDSmanagement of HIV/AIDS

TASO- WFP collaborationTASO- WFP collaborationModelModel

12 months food supplementation of family 12 months food supplementation of family diets, 1293 Kcal/day for 7 family membersdiets, 1293 Kcal/day for 7 family members

Food basket includes – Cereals, Corn Soy Food basket includes – Cereals, Corn Soy Blend, vegetable oil & pulsesBlend, vegetable oil & pulses

Targets clients – TB, ART, PMTCT and Targets clients – TB, ART, PMTCT and OVCsOVCs

Eligibility criteria used to identify Eligibility criteria used to identify beneficiariesbeneficiaries

Food distribution at 7 centers to 7374 clientsFood distribution at 7 centers to 7374 clients

TASO - WFP collaborationTASO - WFP collaborationModelModel

Exit strategy plan communication at Exit strategy plan communication at beginning of food supportbeginning of food support

Beneficiary reassessment before exitBeneficiary reassessment before exit

6 months Food program impact 6 months Food program impact assessment, 2005assessment, 2005

1200 sample clients followed over 12 1200 sample clients followed over 12 monthsmonths

49% of beneficiaries 3 kgs weight gain or 49% of beneficiaries 3 kgs weight gain or moremore

20% 2 kgs gain20% 2 kgs gain 25% no change in weight25% no change in weight 6% lost weight6% lost weight

1010

Moving Up: Moving Up: A Holistic ApproachA Holistic Approach

LOANS and SAVINGS

FOOD AID

Sustainable Livelihoods programming

Family support systemFamily support system

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

Family supportFamily support

Demonstration garden at the Demonstration garden at the center center

ChallengesChallenges High demand for food by clientsHigh demand for food by clients Inability to wean off some clients due to ill healthInability to wean off some clients due to ill health Some clients fail to collect food due to transport Some clients fail to collect food due to transport

costscosts Mobilizing resources & networks for Mobilizing resources & networks for

complimentary sustainable livelihoods complimentary sustainable livelihoods programmingprogramming

Food insecurity / Underlying PovertyFood insecurity / Underlying Poverty

GapsGaps Nutrition surveillance & reference values Nutrition surveillance & reference values

for PLWAsfor PLWAs Nutrition & HIV/AIDS research agenda Nutrition & HIV/AIDS research agenda Capacity & Resources for nutrition & HIV Capacity & Resources for nutrition & HIV

programmingprogramming Referral system for Sustainable livelihoods Referral system for Sustainable livelihoods

programming beyond project supportprogramming beyond project support

Opportunities – WFP, Title II, Opportunities – WFP, Title II, RENEWALRENEWAL

WFP & Title II - Short term food aid, efforts WFP & Title II - Short term food aid, efforts in Sustainable livelihoods programmingin Sustainable livelihoods programming

RENEWAL research collaboration - food RENEWAL research collaboration - food security and HIV programming at TASOsecurity and HIV programming at TASO

Proposed Research StudiesProposed Research Studies

Short term (1 year)Short term (1 year) Secondary data analysis of TASO dataSecondary data analysis of TASO data

Medium term (2 years)Medium term (2 years) Retrospective evaluation and cost-benefit Retrospective evaluation and cost-benefit

analysis of TASO’s sustainable livelihood analysis of TASO’s sustainable livelihood programs (SLP)programs (SLP)

Cost –benefit analysis of nutrition Cost –benefit analysis of nutrition supplementationsupplementation• PLWH and household level analysesPLWH and household level analyses

Long-termLong-term Surveillance of HIV-positive population with a Surveillance of HIV-positive population with a

focus on food and nutrition securityfocus on food and nutrition security• A prospective cohort A prospective cohort

Way ForwardWay Forward Mainstreaming food security into short Mainstreaming food security into short

term Nutrition supportterm Nutrition support Establishing linkages & partnership for Establishing linkages & partnership for

Nutrition securityNutrition security Client empowerment towards Nutrition Client empowerment towards Nutrition

securitysecurity Research partnerships – Research partnerships –

Recommendations to PolicyRecommendations to Policy

Way Forward at TASOWay Forward at TASO Advocacy for increased focus on Advocacy for increased focus on

HIV/AIDS & nutritionHIV/AIDS & nutrition Sustainable livelihoods programmingSustainable livelihoods programming Nutrition program evaluation – tracking Nutrition program evaluation – tracking

body composition, clinical and body composition, clinical and immunological indicesimmunological indices

Strengthening nutritional surveillance & Strengthening nutritional surveillance & researchresearch

AcknowledgementAcknowledgement Clients Clients TASO teamTASO team WFP teamWFP team RENEWAL- Uganda National Advisory RENEWAL- Uganda National Advisory

team & Regional Team team & Regional Team IFPRIIFPRI

Thank youThank you