Nutrition and HIV/AIDSNutrition and HIV/AIDS Overview of agencies' work and Overview of agencies' work and

ProgressProgress

SCNSCNGeneva, 14 March 2006Geneva, 14 March 2006

Randa SaadehRanda SaadehWorld Health OrganizationWorld Health Organization

Nutrition for Health and Nutrition for Health and DevelopmentDevelopment

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Contribution to specific MDG

goals: (1) eradicate extreme poverty and hunger (6) combat HIV/AIDS, malaria and other diseases.

The three diseases "can be

largely controlled through education, prevention andwhen illness strikes,treatment and care".

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What is the role of nutrition in the care and support of PLWHA?

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The Goal of the consultation is The Goal of the consultation is to:to:

Develop evidence-based strategies

Review and disseminate latest scientific evidence and ensure integration

Identify research agenda

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Scientific review on Scientific review on nutrition and HIV/AIDSnutrition and HIV/AIDS

1. MicronutrientsHow HIV infection leads to micronutrients deficiency, and how deficiencies/supplementation may affect various transmission and progression-related outcomes

2. Macronutrients (Energy and Protein)

How HIV infection affects energy/protein requirements, and how deficiencies/supplementation may affect various transmission and progression-related outcomes

3. Infant feeding and HIV transmission

4. Growth faltering and wasting in children

5. Maternal Nutrition or pregnant and lactating women

6. Nutrition and ARVsHow nutrition may affect ARV efficacy and how ARVs may lead to better nutritional status on the one hand and dyslipidemia and insulin resistance on the other

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WHO website – click on WHO website – click on Nutrition and HIVNutrition and HIV

http://www.who.int/nutrition/topics/consultation_nutrition_and_hivaids/en/index.html

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EXECUTIVE BOARD 116TH Session EB116/12117TH Session EB117/7_____________________________________________________

WHO's progress Nutrition and HIV/AIDS on EB agenda in 2005 & 2006 Resolution EB 117.R2 states our policy and framework for action

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In meeting the challenge,

WHO is developing a comprehensive evidence-based strategic approach that will ensure full integration of nutritional care in response to the global AIDS treatment emergency

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach

Nutrition/ HIV/ AIDS Strategic Approach

M & E Indicators

Strengthening & integrating policies

/ Strategies and Programmes

Norms & Standards Science-based

recommendations Guidelines/ tools

Research to fill gaps in clinical &

operational issues

Capacity Building

Collabora

tion w

ith U

N &

oth

er

part

ners

Co-o

pera

tion w

ith s

cienti

fic

com

munit

y

Solid c

om

munic

ati

on s

trate

gie

s

Throughout the stages of disease and age-gender specific

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach (Contd)(Contd)

1. Strengthening & integrating nutrition & HIV/AIDS policies, strategies & programmes

Build on existing efforts Identify nutrition interventions for integration into HIV/AIDS programming Advocacy tools – decision-makers Multi-sectoral collaboration

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach (Contd) (Contd)

2. Developing Norms & Strategies

Support evidence-based findings including micro-nutrient & HIV/IF issues

Nutrition assessment tool – stages of disease, sex & gender-specific

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach(Contd)(Contd)

Guidelines

Review existing ones and develop:

Generic for nutritional care & support for PLWHA

Children & HIV/AIDS Severe malnutrition & HIV IYCF Global Strategy (HIV/IF,

BFHI) Guidelines for providing food

assistance in care and treatment programmes

Guidelines for resource mobilization efforts

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach (Contd) (Contd)

3. Capacity Building

Hospital & community-based health workers

Accelerating training & use of guidelines/tools for infant feeding programmes & PMTCT of HIV

Nutrition counselling courses Revision of curricula & pre-service training

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach (Contd) (Contd)

4 .Research

Developing and implement operational and clinical research to identify effective science-based interventions

Document, publish and disseminate results

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5 pillars of WHO's strategic 5 pillars of WHO's strategic approachapproach (Contd) (Contd)

5. Developing of appropriate M & E Indicators

Measuring progress Measuring impacts Build and complement existing

efforts

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Partners

In house – HIV/AIDS,CAH, RHR, FOS, LEG,

HAC

Other agencies – UNICEF, FAO, UNAIDS, UNHCR

WFP, IAEA, ILO, UNDP

NGOs/Institutions/Universities/National Groups/

Bilaterals/Donors

FAO, HIV/AIDS, Food Security and FAO, HIV/AIDS, Food Security and NutritionNutrition

HIV/AIDS leads to food insecurity, poverty and malnutrition through a number of known pathways at both farm and individual levels.And since good nutrition allows PLWHA to feel better and live longer..

Ensuring food and nutrition security and supporting livelihoods is central to any response.

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To mitigate the effects of HIV/AIDS,To mitigate the effects of HIV/AIDS, FAO FAO

strengthens local capacities for delivering nutritional care and support services

“Living well with HIV/AIDS: A manual on nutritional care and support” and the associated Training course with WHO

supports food security, livelihoods and nutrition of the infected and affected

Guidelines on incorporating HIV/AIDS considerations into food security and livelihoods projects

Guidelines for HIV/AIDS interventions in emergency settings HFS and nut projects ongoing in Lesotho and Malawi for orphans LWHA, and

in Ethiopia, Mozambique and Zambia

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Food and Agriculture Sector StrategiesFood and Agriculture Sector Strategies

Ensure access to food Nutritional care and support Labour and time-saving

technologies and practices Gender equality in access and

control of resources Capacity building Agriculture Knowledge systems Policies

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Overview and objectives of WFP’s nutrition Overview and objectives of WFP’s nutrition and health related HIV/AIDS programmesand health related HIV/AIDS programmes

• Four main activity types:

•PMTCT: 13 countries

•ART: 16 countries

•Home based care: 13 countries

•Support to TB patients: 23 countries

(also have activities supporting orphans, prevention education)

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WFP’s efforts to help build the WFP’s efforts to help build the evidence base related to nutrition, evidence base related to nutrition, food support, HIV/AIDSfood support, HIV/AIDS

INIPSA study: 3 country study in West Africa aimed at understanding the outcomes associated with food support to patients in treatment programs

Collaborations underway with NGO’s and research institutions in Mozambique, Zambia, Uganda, other countries to answer questions of relevance to programming.

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UNICEF activities in nutrition and HIVUNICEF activities in nutrition and HIV

*UN Framework for priority actions on HIV and IF- (13countries)

*National policies on HIV and IF (72 countries)

*Integrating nutrition interventions into PMTCT scale-up plan – joint technical missions in 5 countries

*UNICEF joined WHO in the introduction of IYCF courses

* Jointly with WHO, revised BFHI materials in HIV context

* Support governments in working with OVCs

* Collaborating with WHO in development of guidelines including micronutrient supplementation

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WHO/ The Global FundWHO/ The Global Fund

Development of a "guidance note" to assist countries in incorporating nutrition into funding proposals Meeting of UN Agencies, GFATM, national

representatives, other funders and bilaterals

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Funded HIV/AIDS ProposalsFunded HIV/AIDS Proposals

# of HIV/AIDS funded proposals reviewed per sub-region

14

6

2

5

16

42

0 5 10 15 20 25 30 35 40 45

Eastern Africa

Central Africa

Northern Africa

Southern Africa

Western Africa

Total

# of countries reviewed

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Distribution of proposals by sub-region Distribution of proposals by sub-region (n=42)(n=42)

Eastern Africa(n=14)

Central/Middle Africa

(n=6)

Northern Africa(n=2)

Southern Africa(n=5)

Western Africa(n=15)

BurundiDjiboutiEriteriaEthiopia

KenyaMadagascar

MalawiMozambique

RwandaSomaliaUganda

TanzaniaZambia

Zimbabwe

AngolaCameroon

Central African

RepublicChad

Congo-DRCGabon

MoroccoNorthern

Sudan

BotswanaLesothoNamibia

South AfricaSwaziland

BeninBurkina FasoCote d’Ivoire

GambiaGhana

Guinea Guinea- Bissau

LiberiaMali

MauritaniaNiger

NigeriaSenegal

Sierra LeoneTogo

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Distribution of food and nutrition activities by program Distribution of food and nutrition activities by program area area (n=32 countries)(n=32 countries)

23

17

5

4

0

5

10

15

20

25

Prevention Care Treatment Mitigation

# o

f re

qu

es

ts p

er

pro

gra

m a

rea

Note: 1 country requested support within all 4 program areas

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ProcessProcess

GFATM outlined process by which Board, Secretariat and Technical Review Panel issue call for applications, review and evaluate proposals and manage disbursement of funds

Country presentations of needs re. Nutrition and HIV

Potential nutrition interventions and frameworks for integration discussed in plenary and groups

Indicators for individual subject and project performance monitoring and evaluation considered

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OutcomesOutcomes

A framework on how nutrition interventions can be included in prevention/care/treatment and mitigation activities in HIV programmes

How (some of) these may be included in applications to the GFATM

Planning for training/briefing of regional consultants involved with assisting countries in their applications

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Challenges

Need to act now: balance the needs to fill knowledge gaps and implementing what we know

Building the capacity to make it "universal" and sustainable

Dissemination of information and good communication strategies

Coordination between partners and different players Balance between production of normative work and

country-community level activities

Adequate human and financial resources to put our knowledge into practice.

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Thank youThank you