Intervention - Nutritional Care Models

7/30/2019 Intervention - Nutritional Care Models

1/51

1

Collation of Nutrition and HIV Studies for theStanding Committee for Nutrition, Geneva

Food and Nutrition Technical Assistance Program (FANTA)Academy for Educational Development

April 20, 2006

The following list of on-going food and nutrition studies was based on respondentinformation and is subject to change. Please provide updates or new studies to BruceCogill at [email protected]

1. Neil Jarvis IAEA. Using Isotope Techniques to Assess Nutrition InterventionProgrammes Related to HIV/AIDS in Africa.

2. Mark Manary Univ. Washington, St. Louis. Randomized controlled trialcomparing the impact of nutrition counseling and supplementary feeding witheither RUTF or CSB among wasted adult ART clients in Malawi.

3. Elizabeth Kamau-Mbuthia, University of Vienna/Egerton University, Prof.Ibrahim lmadfa, University of Vienna, Austria The impact of maternal HIV statuson infant feeding patterns and growth in Nakuru, Kenya.

4. RENEWAL Kenya: Elizabeth Byron, Consultant (IFPRI) The Impact of aNutrition Program for People Living with HIV and its Role in Household

Response. Kenya5. RENEWAL Zambia; Petan Hamazakaza, RENEWAL, HIV/AIDS and

Community Resilience in Zambia: Understanding the Implications for Food andNutrition Policies.

6. RENEWAL Malawi: Pauline E Peters The Effects on Rural Livelihoods of HIV-related Illness & Death in Zomba, Malawi: a longitudinal study

7. RENEWAL South Africa: Wayne Twine HIV/AIDS Mortality and the Role ofWoodland Resources in the Maintenance of Household Food Security in a Rural Districtof South Africa

8. RENEWAL Regional 1: Virginia Bond Tuberculosis: An Additional Tipping Stress onPoor Households in South Africa and Zambia.

9. RENEWAL Regional 2: Bruce Frayne RENEWAL Migration, HIV/AIDS and UrbanFood Security in Southern and Eastern Africa ILRI Campus Addis Ababa, Ethiopia10. Anne S.W. Mburu (PI); David L. Mwaniki Centre for Public Health Research;

Kenya Medical Research Institute, Nairobi, KenyaThe Effects ofMultimicronutrient Supplements And Food Rations On The Nutritional StatusAnd Health Of HIV-Positive Adults. UNICEF courtesy of funding from the DutchGovernment

11. Fathia Abdalla, Paul Spiegel, Gebrewold Petros, UNHCR; Implementation ofprogram strategies to integrate HIV/AIDS and nutrition activities in refugeesettings in Uganda and in Zambia.


2/51

2

12. Dr. Robert Kabumbuli, Department of Sociology, Makerere University. Landownership and food security in Uganda: A Study of the use and control of landamong household of women affected by HIV/AIDS in four districts. IFPRI

13. Susan Thurstans, Action Against Hunger Malawi. A pilot programme to assessthe impact of treating acute malnutrition on mortality in adults and adolescentsstarting ARV therapy in Malawi with UN funding.

14. Steve Collins and Paluku Bahwere, Valid International. Acceptability andeffectiveness of nutrition support with a Chickpea-Sesame based Ready-to-Use-Therapeutic Food (CS-RUTF) in chronically sick adults delivered through a homebased care (HBC) program

15. Steve Collins, Valid International. Integrating HIV services into a CommunityTherapeutic Care (CTC) program in Malawi: an operational research study.VALID, SARA/FANTA.

16. Marko Kerac, Steve Collins, VALID International. Moyo RUTF Study: A

randomised controlled trial to compare the efficacy of three new formulations ofReady-to-Use Therapeutic Food (RUTF) in the treatment of severe acutechildhood malnutrition (HIV positive and HIV negative children).

17. Paul Bukuluki RENEWAL Gender dimensions in food/nutrition security and HIV/AIDSin Internally displaced peoples camps in Uganda Makerere University

18. Ann Strauss INIPSA A Nutrition Intervention within a comprehensive ART carepackage with an Impact Evaluation Benin, Burundi Mali WFP.

19. Prof. Maniki and FANTA: Randomized controlled evaluation of the impact of foodsupplements on malnourished HIV-infected adult ART clients and malnourished, HIV-

infected pre-ART adults in Kenya.


3/51

3

No. 1

Operations Research on Food/Nutrition and HIV and AIDS

21 February 2006Complete one table per study

Respond by Friday 3 March, 2006 to [email protected]

1. Your Name, ContactInformation & Date

Programme Management Officer: Neil Jarvis ([email protected])Technical Officer: Najat Mokhtar ([email protected])International Atomic Energy Agency (IAEA)27 February 2006

2. Research Study Title Using Isotope Techniques to Assess Nutrition Intervention ProgrammesRelated to HIV/AIDS in Africa (Project RAF/7/006)

3. OptionalFunding source(s) and level offunding

IAEA Technical Cooperation FundUS$ 1.1 million

4. Name of Organization andPrincipal Investigator(s)

Participating countries having obtained national ethical clearance:

1. BotswanaNational Food Technology Research CentrePrincipal Investigator has changed we await nomination of new PI.

2. CameroonCentre for Food and Nutrition ResearchMs. Marie-Thrse Garba

3. EthiopiaEthiopian Health and Nutrition Research Institute (EHNRI)Mr. Habtamu Fufa

4. GhanaGhana Atomic Energy Commission (GAEC)Ms. Rose Boatin

5. SenegalUniversit Cheikh Anta Diop de Dakar (UCAD)Prof. Salimata Wade

6. Uganda

TASO/Ministry of HealthMs. Christine Nabiryo

6. United Republic of TanzaniaTanzania Food and Nutrition CentreDr. Godwin Ndossi

Participating countries working towards national ethical clearance:

1. Kenya


4/51

4

University of NairobiMs. Christine Mwangi

2. South AfricaUniversity of KwaZulu-NatalProf. Anna Coutsoudis

3. ZambiaNational Institute for Scientific and Industrial Research (NISIR)Ms. Rodah Zulu

4. ZimbabweMinistry of Health and Child Welfare (MOHCW)Ms. Rufaro Madzima

5. Partners in study WHO/AFRO

6. Duration/Timeline Started 2004- final report by 20087. Objectives To assess the efficacy of food-based national strategies that promote intake

of essential nutrients using isotope-based techniques on HIV-infectedvulnerable groups using isotope techniques; and to provide evidence forpolicy decisions

8. Rationale for study Nutrition plays a critical role in health care and support for people livingwith HIV/AIDS (PLWHA). Nutritional interventions can help in managingsymptoms, promote response to medical treatment, slow progression of thedisease, and increase the quality of life by improving daily functioning.Several countries in Africa are initiating nutrition interventions based offood supplementation. The aim of this project is to evaluate theseinterventions and assess their efficacy.

9. Study question(s) Does the supplemented food increase body lean mass of PLWHA?

10. Study Design Efficacy study, self controlled, community based

11. Describe intervention/ inputssuch as counseling, food/nutrientsupplements frequency of inputs

In response to several requests from Member States implementing nutritionintervention programmes for PLWHA, project RAF/7/006 is providingequipment, expert services and training related to the use of isotopictechniques to assess the efficacy of the national programmes.

12. Estimated number ofsubjects, eligibility criteria anddescription (age, HIV status, etc.)

The following criteria relate to the inclusion of the participant in the study

and not to access to the food being provided under the intervention

campaign.

Efficacy study with separate control groups or participant self-

control as appropriate to the local situation;

Sample size per group at baseline data collection stage: minimum of100 to allow for sufficient data at the end of the study given that

attrition is expected;

Community based;

On-site (controlled) feeding/food rations or directly observed by

community based workers as appropriate for local conditions;Age of


5/51

5

participants: 18 - 45 years with equal number of males and females

if possible;

BMI less than 25kg/m3;

Sero-positive participants classified at clinical stage I, II or III of the

WHO staging system for HIV infection;

CD4 greater than 200 cell count/mm3;

Participant consent.

The following criteria relate to the exclusion of the participants in the study

and not to access to the food being provided under the intervention

campaign.

Pregnant women

Those under 18 and above 45 years;

CD4 below 200 cell counts/mm3;

Sero-positive participants classified at clinical stage IV or advanced

Stage III of the WHO staging system for HIV infection;

Mentally challenged;

Bed-ridden; Anyone already consuming any form of nutritional supplement

13. Outcome measures Performance indicators1. Data on body composition/nutritional status of PLWHA, according tostudy designs in at least four participating countries, collected and analyzedby December 2007.2. Completion of reports to be submitted to health sector decision-makers inat least four participating countries by December 2007.

14. Location of Study Community based in participating countries15. Published reports (website ifavailable)

None as yet.

16. Expected date of final report/publications

End 2008

17. Additional Comments


6/51

6

No. 2

Operations Research on Food/Nutrition and HIV and AIDS


Bruce Cogill, FANTA Project/AED; [email protected] 23February, 2006

2. Research Study Title Randomized controlled trial comparing the impact ofnutrition counseling and supplementary feeding with eitherRUTF or CSB among wasted adult ART clients in Malawi

3. OptionalFunding source(s) andlevel of funding

USAID (PEPFAR) FANTA Project/AED, Washington Univ.St. Louis, Univ. Malawi

4. Name ofOrganization andPrincipalInvestigator(s)

Mark Manary, Washington Univ. St. Louis

5. Partners in study FANTA Project/AED, Washington Univ. St. Louis, Univ.Malawi

6. Duration/Timeline Start January 2006 Final Report December 2007 Publication2008

7. Objectives Compare the impacts of supplemental ready-to-use-therapeutic food (RUTF) to the impacts of corn soy blend(CSB) on nutritional/clinical outcomes and overall quality oflife among wasted adult antiretroviral therapy (ART) clientsin Malawi

8. Rationale for study In order to strengthen the evidence base about the impacts offood supplementation on the nutritional and clinical status ofHIV-infected individuals, FANTA is working with localpartners to conduct a targeted evaluation of specifictherapeutic food on adult subjects taking ARVs.

9. Study question(s) What are the health, nutrition and quality of life benefits offood supplementation for wasted adult receiving regular ARTin Malawi

10. Study Design Random assignment of treatment with RUTF and nutritioncounseling

11. Describeintervention/ inputssuch as counseling,food/nutrientsupplements frequencyof inputs

Subjects will be randomly assigned to receive one of twointerventions (225 in each group):Group I: 260 g/d of RUTF and nutrition counseling, orGroup II: 374 g/d of CSB and nutrition counselingRUTF is produced locally in accordance with Nutrisetspecifications (Plumpynut) and the CSB procured from theUS and follows the World Food Programme formulation.The two food products are designed to provide 45% of thedaily estimated average requirement for energy.

12. Describeintervention deliverymechanisms used in thestudy. Thatis, how was the

ARVs and RUTF provided at ARV therapy clinic at theQueen Elizabeth Central Hospital in Blantyre, Malawi. Thefood will be distributed monthly in conjunction with a follow-up visit. All participants will receive the standard nutritionalcounseling for healthy eating with HIV.


7/51

7

intervention delivered(e.g., at home, bycommunity

groups, as part ofantenatal care, throughmobile clinics, atImmunization clinics,with growthmonitoring)?

13. What process data,if any, were gatheredon how well thedelivery worked (e.g.,coverage, attendance,operational feasibility,

distribution)?

Data include a history of current clinical symptoms (fever,cough, vomiting, appetite and diarrhea) and their durationwill be elicited, as well as any medications or other medicaldiagnoses. Questions to determine the compliance with theART will be asked, as well as pill counts made, once subjectshave started ART. A focus group interview will be

conducted with a subset of randomly selected individualsfrom each of the two groups to explore alternative uses of thefood and sharing of the food within the household.

14. Estimated numberof subjects, eligibilitycriteria and description(age, HIV status, etc.)

total 450Eligible subjects will be adults (> 18 years old) diagnosedwith AIDS and scheduled to begin treatment with ARTwithin 3 months with a body mass index (BMI) of < 18.0.All women who say that they are pregnant or lactating will beexcluded. Subjects will be recruited from individualsattending the ARV therapy clinic at the Queen ElizabethCentral Hospital in Blantyre, Malawi under the supervision ofphysicians of the Internal Medicine Department, College of

Medicine, University of Malawi15. Outcome measures Basic socio-demographic data will be collected; such as birth

date, age, sex, address, occupation, and measures ofeconomic status. A quality of life assessment will beadministered. Data on subjects nutritional status (BMI, BIA,and serum albumin), clinical status (viral load, CD4 count,clinical events), quality of life, and adherence to ARV drugswill be collected for the three months of supplementation andfor nine months of follow-up.

16. Location of Study Communities around the Queen Elizabeth Central Hospital inBlantyre, Malawi

17. Published reports

(website if available)

N/A

18. Expected date offinal report/publications

December 2007 with publication in mid-2008

19. AdditionalComments

Institutional Review Board approval in US and Malawicompleted.


8/51

8

No. 3Operations Research on Food/Nutrition and HIV and AIDS

23 February 2006


Elizabeth Kamau-Mbuthia, University of Vienna/EgertonUniversity, [email protected], Feb 2006

2. Research Study Title The impact of maternal HIV status on infant feeding patternsand growth in Nakuru, Kenya


North-South-Dialogue scholarship program-AustriaDoctorate studies


University of ViennaElizabeth Kamau-Mbuthia

5. Partners in study Prof. Ibrahim Elmadfa, University of Vienna, Austria6. Duration/Timeline Data collection-Feb 2004-July 2005, final report in March

2006 and publications thereafter.7. Objectives Assess maternal (HIV infected and uninfected) nutritional

status during pregnancy and when lactating, birth outcomes,infant feeding patterns and growth from birth to fourteenweeks.

8. Rationale for study To assess the kind of feeding patterns that mothers of knownHIV status are using for their children and the effects this ishaving on infant growth and whether they actually adhere toinfant feeding practices as recommended.

9. Study question(s) Is maternal HIV status having an effect on infant feedingpatterns adapted and are these choices having an effect oninfant growth, are mothers adhering to infant feedingrecommendations?

10. Study Design Longitudinal and observational


No interventions put in place in this study but the mothersrecruited were going through the PMTCT of HIV program atthe Provincial General Hospital,Nakuru, Kenya where theyreceived counseling on HIV related issues and general healthand nutrition. Some also received nutrient supplements.

12. Estimated number

of subjects, eligibilitycriteria and description(age, HIV status, etc.)

280 pregnant women recruited at beginning of study. Women

who went through PMTCT program at the hospital and knewtheir HIV status, age ranged 15-40 years. Followed frompregnancy through delivery and with infant upto fourteenweeks during immunization clinics.

13. Outcome measures Sociodemographic data of HIV infected and uninfected(acting as controls) women, their nutritional status throughanthropometry and dietary intake. Infant feeding patterns andgrowth at intervals from birth, 6, 10, 14 weeks. Associationbetween maternal nutritional status and infant feeding patternand growth by fourteen weeks.

14. Location of Study Provincial General Hospital, Nakuru, Kenya

15. Published reports N/A


9/51

9


16. Expected date offinal report/

publications

March 2006


Approved by The ministry of Education, research section,Kenya and the hospital administration.


10/51

10

No. 4RENEWAL-Kenya


Elizabeth Byron, Consultant (IFPRI), [email protected], February 2006

2. Research Study Title The Impact of a Nutrition Program for People Living with HIV and its Role inHousehold Response

3. OptionalFunding source(s) and levelof funding

1. RENEWAL-Kenya - $47,0912. USAID-Food For Peace funding for Post Doctoral Consultant

4. Name of Organizationand Principal Investigator(s)

Mabel N. Nangami, Dept. of Health Management, Moi University, KenyaElizabeth Byron, IFPRIAbraham M. Siika, Dept. of Medicine, Moi University, KenyaKara Wools-Kaloustian, Indiana University School of MedicineStuart Gillespie, IFPRI

Markus Goldstein, The World BankJoshua Graff-Zivin, Dept. of Health Policy and Management, ColumbiaUniversityCristian Pop-Eleches, Dept. of Economics and SIPA, Columbia University

5. Partners in study Moi University, AMPATH, Indiana University School of Medicine,International Food Policy Research Institute (IFPRI), Columbia University,The World Bank

6. Duration/Timeline December 2005 to Sept 20067. Objectives To understand how provision of ARVs and nutritional support interact to

mitigate health and economic impacts of HIC at the patient, household andcommunity level and assess how such nutritional support programs influencepre-existing informal support networks within the community.

8. Rationale for study Reconstitution of the immune system after initiation of antiretroviral treatment

is associated with an individuals nutritional status and subsequent dietaryintake. The goal of this study is to examine the ability of nutritionalinterventions to improve both the nutritional status of ARV patients and theresilience of their households in the context of pre-existing social supportnetworks.

9. Study question(s) 1. Which households do better at maintaining nutritional status in the face ofthe onset of AIDS and which factors are associated with this?2. What are the food distribution and allocation patterns within thesehouseholds between the HIV patients and their children?3. Who provides transfers to HIV patient households and how does supportchange through the course of disease and treatment?4. Do the food supplements buffer any deleterious impacts on householdnutrition, educational attainment, income, and labor supply?

5. What, if any, are the community level impacts?6. How sustainable is this approach and what are the implications for scalingup the program?

10. Study Design Combination of clinical data, socioeconomic household survey, and in-depthqualitative research methods. Sample is patients and households in thecatchment area of the Mosoriot Rural Health Center in Kosirai Division.

11. Describe intervention/inputs such as counseling,food/nutrient supplementsfrequency of inputs

WFP provides 50% of RDA to eligible patients on ARVs and their householdmembers for period of 6 months. Eligibility is determined by BMI below 19,CD4 count below 200, and insufficient access to food to support patientrecovery. Intended for patients starting ARV treatment after June 2005.

HAART and Harvest Initiative (HHI) provides locally grown fresh foods(dairy, eggs, vegetables) to wider range of patients on ARVs in addition to


11/51

11

those receiving WFP supplements. Intended for patients on ARVs since2002 who qualify and as supplement to WFP food basket.

Nutrition education and counseling provided to all ARV patients at clinicregardless of participation in nutrition supplement program.

Patients collect food at weekly, and monthly intervals depending on distancefrom distribution sites.

12. Describe interventiondelivery mechanisms usedin the study. Thatis, how was the interventiondelivered (e.g., at home, bycommunitygroups, as part of antenatalcare, through mobile clinics,atImmunization clinics, withgrowth monitoring)?

Intervention is delivered as part of ARV treatment program through healthclinic. The nutritionist writes a nutritional prescription for each patient eachmonth and then the patient takes this to the supplement collection points.There are 5 distribution sites located throughout the patient catchment areawhere patients or a designated caregiver report to collect the nutritionsupplements at weekly or monthly intervals.The nutrition supplements are free, but patients are responsible for transportto collect the food. Many collect food on the same day as their clinical check-ups.Patients enrolled in food program after June 2005 and eligible for foodreceive both WFP and HHI foods. Patients enrolling in program prior to June2005 are eligible for HHI food only.

13. What process data, ifany, were gathered on howwell the delivery worked(e.g., coverage,attendance, operationalfeasibility,distribution)?

Key informant interviews with program staff involved with the interventionwere conducted. There may be analysis of collection records with theclinical data in the future, none at this time.

14. Estimated number ofsubjects, eligibility criteriaand description (age, HIVstatus, etc.)

In-depth research: 20 Key informants, 9 focus group discussions, and 80individual patient interviews.Survey: 862 householdsClinical data: approximately 1000 patients total from 4 groupings below.Group 1 Patients starting ARVs June Dec 2005 and enrolled in foodsupplement programGroup 2 Patients starting ARVs June Dec 2005, but not in food supplementprogramGroup 3 Patients starting ARVs June 2004-Jan 2005 and at one timereceiving HHI food.Group 4 Patients starting ARVs June 2004-Jan 2005 but never receiving anyfood from program.

15. Outcome measures Pairwise comparisons between patient groups (food and non-food) involvingcontinuous outcome measures using a t-test. Compare CD4 counts frombaseline to 6 months for newly enrolled ARV patients, nutritional status (BMI)and comparison of rate of occurrence of opportunistic infections, drug

toxicity, adherence, mortality, and loss to follow-up.Build on 3 rounds of panel dataset

16. Location of Study Mosoriot Rural Health Center and catchment area, Kosirai Division, westernKenya

17. Published reports Not yet available18. Expected date of finalreport/ publications

Qualitative data report by August 2006Household Survey report by December 2006Clinical Data analysis by November 2006

19. Additional Comments Study is ongoing. Qualitative fieldwork completed Feb 28, 2006. Survey tobegin mid-March 2006 and run through Sept. 2006. Clinical data arecurrently being collected through patient electronic medical records systemand analysis to begin in June 2006.


12/51

12

No. 5RENEWAL Zambia


Petan Hamazakaza, RENEWAL, c/o Zambia Agriculture Research Institute,Box 630090, Choma, Zambia; [email protected], March 1, 2006

2. Research Study Title HIV/AIDS and Community Resilience in Zambia:Understanding the Implications for Food and Nutrition Policies


RENEWAL- $ 43,344.00MSU-FSRP training and staff timeIFPRI Staff time


Petan Hamazakaza (ZARI)Elizabeth Byron (IFPRI)Mukelabai Ndiyoii (FASAZ)Albert Chalabesa (MACO-ZARI)T.S. Jayne (MSU- FSRP)

Stuart Gillespie (IFPRI)Suneetha Kadiyala (IFPRI)

5. Partners in study Farming Systems Association of Zambia (FASAZ), Zambia AgricultureResearch Institute (ZARI),International Food Policy Research Institute (IFPRI),MSU Food Security Research Project (FSRP),Ministry of Agriculture and Cooperatives (MACO)

6. Duration/Timeline February 2005 to May 2005 (Fieldwork)7. Objectives The overall goal of this study is to enhance local policy makers

understanding of the ways in which key Zambian food security and nutrition-relevant policies and programs may need to be modified so as to strengthenthe resistance and resilience of rural farming households and communities to

HIV/AIDS without sacrificing the contribution of such policies and programsto other national objectives. Specific objectives follow:Understand the what determines household and/or community levelresistance to HIV infection;Understand how households and communities affected by HIV/AIDSresponded to livelihood shocks such as livestock disease, the 2002 droughtand the subsequent food crisis and how this differed from those relativelyless affected by HIV/AIDSAssess why some communities display resilience to the AIDS diseasedespite relatively high levels of prime-age adult mortality and current chronicillness while other communities do notIdentify strengths and weaknesses of community-level institutions withregard to their ability to respond to HIV/AIDS

Elucidate the pathways through which a selection of key food security andnutrition-relevant policies and programs strengthen or weaken householdand community resistance and resilience to HIV/AIDS.Formulate an advisory note for policy makers based on research findingsand policy review processes.

8. Rationale for study Until recently, national policy makers in Zambia and many other countries inthe region have tended to view HIV/AIDS as a problem for the Ministry ofHealth and the broader health community to address. Yet it is becomingincreasingly clear that policies and programs in other sectors, such as thoseunder the purview of the Ministries of Agriculture and Cooperatives, andTrade and Industry, may have unintended effects on the spread of HIV/AIDSand the ability of households and communities to withstand the hardshipscaused by the disease.


13/51

13

9. Study question(s) What are the characteristics of households and communities1

that have lowHIV prevalence rates (as measured by adult mortality due to chronic illnessand current chronic illness), especially those with significant levels of other

known determinants (i.e. positive outliers)?

How do rural households and communities affected by HIV/AIDS respond tofood production shortfalls, and how do these households and communitiesdiffer in their responses from non-afflicted rural households andcommunities? The study will attempt to learn about differential responses tothe 2001/02 food crisis in Zambia as a specific case, although the study aimsto review more broadly the Zambian agricultural and food security-relatedfactors affecting rural household and community responses to the HIV/AIDSpandemic.

What are the ways in which existing community-level capacities aremobilized in response to HIV/AIDS and are there capacity gaps orweaknesses that may have constrained the effectiveness of theseresponses?

What are the major institutional and policy factors that affect communityresistance and resilience to the HIV/AIDS pandemic?

10. Study Design Study conducted by multi-disciplinary team; anthropologist, nutritionists,economists and agronomists.

Selected study area which is agricultural based, but experiencing worstlivelihood impacts (drought, livestock diseases, )Selected four communities all of which had adult mortality higher thanprovincial HIV prevalence. Data collection comprised of quantitativeinterviews for 45 50 households in each community, focus groupdiscussions with gender disaggregated groups (men, women and combined

men and women group), key informant interviews and also 15 in-depth casestudies in each community for shocked households (i.e. death, chronicillness, fostering orphans, widow headed)The study focused on four ruralcommunities, stratified by prime-age adult mortality rates and indicators ofcommunity resilience. We conducted a quantitative household survey to atotal of 179 households and followed up 60 of the households withqualitative in-depth interviews. We also held community meetings anddiscussions.


N/A

12. Describe intervention

delivery mechanisms usedin the study. Thatis, how was the interventiondelivered (e.g., at home, bycommunitygroups, as part of antenatalcare, through mobile clinics,atImmunization clinics, withgrowth monitoring)?

N/A


14/51

14

13. What process data, ifany, were gathered on how

well the delivery worked(e.g., coverage,attendance, operationalfeasibility,distribution)?

Household Survey includes data on participation in Government of ZambiaFood Security and Social Welfare Programs (Fertilizer Support Program,Food Security Pack, and Social Welfare Program)


179 household surveys60 in-depth follow up interviews from 4 rural areas in Southern Province.

15. Outcome measures16. Location of Study Southern Province: Pemba area in Choma district, Garner Farm/Musikili

area in Mazabuka district, Banamwaze chiefdom in Itezhi tezhi, Makunkaarea in Kazungula district.

17. Published reports(website if available) Paper presented at ASSA in December 2005First report to be published on www.ifpri.org/renewal/index.htm in June 200618. Expected date of finalreport/ publications

June 2006

19. Additional Comments Study is complete and in analysis phase.


15/51

15

No. 6

RENEWAL Malawi


Pauline E Peters; Malawi contacts: [email protected]; 01 525 122; 09640 833

2. Research Study Title The Effects on Rural Livelihoods of HIV-related Illness & Death in Zomba,Malawi: a longitudinal study


IFPRI RENEWAL $46,500 + Fulbright-Hayes $6000 (field expenses) +Kennedy School, Harvard $4000


Harvard University and Chancellor College, U of Malawi (Peters); BundaCollege of Agric, U of Malawi (Daimon Kambewa); U of Oregon (PeterWalker)

5. Partners in study University of Malawi6. Duration/Timeline January-December 2006

7. Objectives To investigate shifts and persistences in household composition, livelihoodstrategies, expenditures, access to land, social networks, and communityorganization consequent on increased morbidity and mortality related toHIV/AIDS among households, families and villages originally studied in1986.

8. Rationale for study The main rationale is the unusual ability to provide a before and afterassessment of the effects of rising deaths and chronic illness on ruralfamilies. And thereby, to provide assessment and possible amendment tocurrent interpretations of and actions taken in response to rising death andillness.

9. Study question(s) What changes or persistences are seen in agricultural production patterns,access to land, income and expenditure levels and patterns, anthropometricmeasures, social networks, access to services, etc.

10. Study Design A combination of questionnaire-based surveys to provide quantitative dataand ethnographic or qualitative study. The methods are those used in thebaseline study of 1986 and subsequent restudies in 1990 and 1997.


None

12. Describe interventiondelivery mechanisms usedin the study. Thatis, how was the interventiondelivered (e.g., at home, bycommunity

groups, as part of antenatalcare, through mobile clinics,atImmunization clinics, withgrowth monitoring)?

None


n/a


16/51

16

14. Estimated number ofsubjects, eligibility criteriaand description (age, HIV

status, etc.)

Total sample for 2006 is 250 households but the number present since 1986is 175 (+ 6 or 7 daughter hhds formed by 1/2006). No testing is done soproxy for HIV-related illness are statements by the individual/family, and/or

symptoms.15. Outcome measures See 8 above16. Location of Study Zomba South, Malawi17. Published reports(website if available)

none

18. Expected date of finalreport/ publications

After June 2007

19. Additional Comments IRB approval from Harvard University and approval by University of Malawireview board


17/51

17

No. 7RENEWAL South Africa


Wayne TwineSchool of Animal, Plant & Environmental SciencesUniversity of the Witwatersrand (South Africa)Tel: +27 15 7937500Fax: +27 15 793 [email protected]

02 March 20062. Research Study Title HIV/AIDS Mortality and the Role of Woodland Resources in the

Maintenance of Household Food Security in a Rural District of South Africa.

3. Optional

Funding source(s) and levelof funding

RENEWAL/IFPRI


Wayne Twine:School of Animal, Plant and Environmental Sciences,University of the Witwatersrand (South Africa)Lori Hunter:Institute for Behavioral Sciences,University of Colorado at Boulder (USA)

5. Partners in study Wits-MRC Agincourt Health and Population Unit, University of theWitwatersrand (South Africa)South African National Department of Water Affairs and Forestry

6. Duration/Timeline 2006-20077. Objectives To examine food security among HIV-impacted households in rural South

Africa (as compared to non-HIV-impacted households) with a particularfocus on the role of woodland resources (e.g. wild foods) in shapinghousehold resilience or vulnerability following the death of a prime-age adult.

8. Rationale for study Although woodland resources (also referred to as non-timber forest products(NTFPs)) are a standard dietary component in Africa (Gockowski et al 2003;Shackleton et al. 2000; Steyn et al. 2002; Twine et al. 2003), few data existon the specific role of these resources in the maintenance of household foodsecurity among HIV-impacted households (Barany et al. 2001). In thiscontext, it is also unknown what the influence might be of cash savings orincome generated through the use or sale of woodland resources as copingstrategies (e.g. using fuelwood instead of paraffin or electricity to be able toafford to buy food). Indeed, to-date the environmental dimensions of theHIV/AIDS pandemic remain little explored, despite the centrality of thenatural environment in the livelihoods of the rural poor across Africa. Aspointed out by Hammarskjold (2003:6), What has been published hithertoon the subject is therefore based on fragmentary and anecdotalinformation.It is important that this information gap be addressed, given that sub-Saharan Africa is generally typified by the interlinked phenomena of rapidlyrising rates of HIV infection, high levels of food insecurity, high dependenceon natural resources for rural livelihoods, climatic variability andenvironmental degradation (Barany et al 2001; Holden & Shiferaw 2004;Misselhorn 2005). Nowhere is this more urgent than in southern Africa,which has the highest rates of HIV infection in the world (UNAIDS 2004).

9. Study question(s) 1) What role do woodland resources play in contributing to household foodsecurity following the death of a prime-age adult due to AIDS?


18/51

18

2) Are otherwise similar HIV-impacted households more food secure ifthey have better access to local woodland resources?

3) How do poverty, poor availability of local woodland resources and the

death of a prime-age adult interact to shape household vulnerability tofood insecurity?10. Study Design There are 4 data sources proposed for this examination.

Data Source #1, Ongoing Demographic Surveillance System: Insight into thedemographic characteristics of Agincourt residents will be provided throughthe Wits-Medical Research Council Agincourt Health and Population Units(AHPU) longitudinal health and demographic surveillance system (HDSS).Since 1992, the AHPU has collected census data at 12-18 month intervalsfrom all 11,000 households in the Agincourt sub-district. The resulting dataare incredibly rich in demographic and socio-economic detail, allowingidentification of key household characteristics (e.g., size, male/femaleheadship, age composition, socio-economic status).Data Source #2, Quantitative Survey:We aim to survey 300 households in amaximum of 10 villages within the Agincourt field site, in order to collect dataon food security, adaptive livelihood strategies and on household use ofwoodland resources.

Data Source #3, Qualitative Interviews: Following preliminary analyses ofthe first half of the survey data (data source#2), we will undertaken 30 in-depth, qualitative interviews to supplement the quantitative insights, andsuggest any additional data needs for the remainder of the data collectioneffort.Data Source #4, Remote Sensing and Ground-Truthing: Ecosystem statusand local availability of natural resources around study villages will beassessed using remotely sensed data (satellite images and aerialphotographs). These data will be ground-truthed by quantifying thevegetation cover and structure using accepted ecological field methods.

We aim to sample 300 households with the quantitative survey. We willselect our survey sample based on the two central dimensions of 1) mortalityexperience in last two years and 2) local availability of woodland resources.Mortality strata to be used are a) HIV mortality, b) non-HIV mortality and c)no mortality (of prime-age adults). We plan to sample non-HIV mortalityhouseholds since we will not able to directly address the question of HIVmorbidity in this study. More specifically, by comparing households with HIVand quick non-HIV deaths (such as heart attack or motor vehicle accident),we hope to be able to indirectly capture some of the unique impacts of HIVmortality, which include a preceding long period of illness.

Recall that poverty represents another dimension of vulnerability examined

within this research. That said, we will not stratify the study populationbased upon this dimension, since variation representative of the populationcan be expected to occur within the sample. Socio-economic status (SES)from wealth ranking will be obtained for households from the AgincourtHealth and Population Units database. Wealth ranking is based onhousehold ownership of assets (e.g. appliances) and access to services andamenities (e.g. a water tap in the yard). Stratification by SES will occurduring analysis phase of the study.


This study will not have direct intervention inputs. Rather, it is aimed atgenerating new information to inform policy. To this end, we have partneredwith a national government department to help facilitate the effective andappropriate flow of information to policy makers. We will also partner withthe Agincourt Health and Population Unit in communicating research findings


19/51

19

back to the local community and government structures in the study site.12. Describe interventiondelivery mechanisms used

in the study. Thatis, how was the interventiondelivered (e.g., at home, bycommunitygroups, as part of antenatalcare, through mobile clinics,atImmunization clinics, withgrowth monitoring)?

It is envisaged that feedback to national policy will be in the form ofworkshop meetings and a policy brief, facilitated by our government partner.

Communication of results and lessons learnt to the local structures will bevia the Agincourt Health and Population Units existing community feedbackmechanisms, which include community meetings, research result factsheets, and a community research forum.

13. What process data, ifany, were gathered on howwell the delivery worked(e.g., coverage,

attendance, operationalfeasibility,distribution)?

NA


NA

15. Outcome measures NA16. Location of Study The study site comprises the Agincourt sub-district of the Bushbuckridge

rural municipality, in the far north-east of South Africa. This border regionpreviously fell under Limpopo Province, but has recently been transferred toMpumalanga Province. The field site, named after one of the local villages,consists of 21 villages, comprising over 11,000 households and 67,000people. Village population size ranges from 480 to 6,834. The area istypical of rural communities across South Africa, and is characterised bypoverty, high human densities, and a high reliance on natural resources, onremittances from a large migrant population, and social security grants.

17. Published reports(website if available)

Previous reports from a CICRED-funded project also dealing with HIV/AIDSand resource use:

1. Hunter, L.M. & Twine, W. (2005) Adult mortality, natural resources andfood security: evidence from the Agincourt field site in rural South Africa.Working Paper EB2005-0001, Environment and Behavior ResearchProgram, Institute of Behavioural Sciences, University of ColoradoBoulder (USA). http://www.colorado.edu/ibs/pubs/eb/eb2005-0001.pdf

2. Hunter, L. M., Twine, W & Johnson, A. (2005) The Role of NaturalResources in Coping with Household Mortality: An Examination in Rural

South Africa. IBS Working Paper: EB2005-0004:http://www.colorado.edu/ibs/pubs/eb/eb2005-0004.pdf


December 2007

19. Additional Comments NA


20/51

20

No. 8

RENEWAL Regional 1


Virginia Bond, Tel: 260 1 97 846 726, [email protected], 1st

March 2006

2. Research Study Title Tuberculosis: An Additional Tipping Stress on Poor Households in SouthAfrica and Zambia


RENEWAL, IFPRIUS$110,000


ZAMBART Project, Zambia (Lead)

nd Tutu TB Centre, Stellenbosch University, SA

Principal Investigator: Virginia Bond

5. Partners in study , provincial & central health authorities in Zambia and Western Cape

ZAMSTAR clinical trial funded by Bill & Melinda Gates Foundation, 2004-2010, CREATE Consortium

6. Duration/Timeline March 2006 August 20077. Objectives Anthropological research to detail impact of convergences of TB, food

insecurity and HIV at household level in one rural community (Zambia) andone peri-urban community (Western Cape)

8. Rationale for study To address emergent phenomena of rural tuberculosis and the advancedHIV epidemic with an inbuilt comparison between Zambia and South Africafrom perspective of households (with urban-rural linkages)

9. Study question(s) - What food issues are particular to TB?- What are the livelihood strategies of households covering food

needs in event of TB illness?- What is the role of power, gender, rural location and marginality in

determining access and stress experienced by households facingthese adversities?

- What are the differences and similarities between Zambia and SouthAfrica?

10. Study Design 10 months anthropological fieldwork carried out in 20 households (10 TBpatient, 10 non TB patient) in 2 ZAMSTAR sites in Zambia and WesternCape.


None attached to this funding and study.

12. Describe interventiondelivery mechanisms usedin the study. Thatis, how was the interventiondelivered (e.g., at home, bycommunitygroups, as part of antenatalcare, through mobile clinics,atImmunization clinics, withgrowth monitoring)?

None attached to this funding and study.

13. What process data, ifN/A


21/51

21

any, were gathered on howwell the delivery worked(e.g., coverage,

attendance, operationalfeasibility,distribution)?14. Estimated number ofsubjects, eligibility criteriaand description (age, HIVstatus, etc.)

20 TB patient households (10 SA, 10 Zambia)20 non-TB patient households (10 SA, 10 Zambia)Key adult informants in household = TB patients, Key woman, Head ofHousehold. HIV status of TB patients will be known as part of widerZAMSTAR study.

15. Outcome measures Measures of community food flows recall and during fieldwork. Athousehold level, anthropometric measurement of children & food stocks,sales & expenditure; health events & morbidity; labour; seek stocks; meals.Household indicators of environmental & structural resources, householdstructure, household resources, social resources & individual resources.

Multi-dimensional typology of households cast according to high, middle,low capability of households to cope with TB as a stress additional to foodinsecurity & HIV/AIDS. Analysis will look at how households combine,utilise, exploit and allocate household resources (skills, work and material) inresponse to TB illness, HIV and food insecurity.

16. Location of Study Pemba/Batoka, Choma District, Southern Province, ZambiaMbekweni, Paarl District, Western Cape, SA


NA


August 2007

19. Additional Comments This is a qualitative study of small numbers which will allow a coping patternto emerge on a qualitative scale from which we will develop a set ofindicators that could be applied more rapidly and broadly by a wider set ofdisciplines and stakeholders.


22/51

22

No. 9RENEWAL Regional 2


Bruce Frayne, PhDRENEWAL Regional Coordinator / Research FellowInternational Food Policy Research Institute (IFPRI)PO Box 5689, ILRI CampusAddis Ababa, EthiopiaTel: +251-(0)11-6463215 ext. 274

1 March 20062. Research Study Title Migration, HIV/AIDS and Urban Food Security in Southern and Eastern

Africa3. Optional

Funding source(s) and levelof funding

International Development Research Centre (IDRC)

Ottawa, Canada$384,000


RENEWALInternational Food Policy Research Institute (IFPRI)PI Bruce Frayne

5. Partners in study Southern African Migration Project (SAMP) Southern African ResearchCentre (SARC)Queens UniversityKingston, K7L 3N6, Canada

6. Duration/Timeline 3 years (2007-2009)7. Objectives The objective of this project is to better understand the interactions between

migration, HIV/AIDS and food and nutrition security in Southern and EasternAfrica, with a focus on the urban-rural food supply and the food security of

migrants in the city.8. Rationale for study The project situates itself at the nexus of migration, HIV/AIDS and urban

food security, which interact in complex ways that are little researched andunderstood in the Southern and Eastern African context. While urban to ruralremittances has been the predominant direction of commodity and cashtransfers, benefiting the rural household economy, this dynamic is changing,with direct food transfers from rural households to urban households on therise, as part of the migration process and urbanization process. However,while migration itself fuels the rapid spread of HIV in the region, the diseasemay be undermining this new social economy and urban food securitythrough its impacts on rural production for the towns. In addition, HIV/AIDSmay be diminishing the capacity of migrants to pursue other food securitystrategies in town too, including urban agriculture. The virus long wave

epidemiology creates impacts in both the short and long terms,simultaneously changing the development context while creatingintergenerational impacts that call for a next generation approach to thechallenge of developing proactive, future oriented policy and programming.

9. Study question(s) a) What is the contribution of rural food production at the householdlevel for the food budget of urban households?

b) To what extent is HIV/AIDS impacting both rural and urbanhousehold food security?

c) How and to what degree are these impacts magnified or amelioratedby rural-urban migration and rural-urban linkages at the householdlevel?

d) What role does urban agriculture play in meeting the food gap ofurban households, and is this influenced by HIV and AIDS?


23/51

23

e) Based on the research findings, what policy and programminginterventions are required to address the development challengesposed by the triple threat of migration, HIV/AIDS and food

insecurity?10. Study Design Project in planning phase, but will include households surveys11. Describe intervention/inputs such as counseling,food/nutrient supplementsfrequency of inputs

This project will provide baseline information and analysis on therelationships between HIV/AIDS, the urban-rural food supply and the foodsecurity of migrants in the city. The findings will be communicated withnational and city governments and recommendations developed formainstreaming migration in food security and HIV/AIDS prevention andintervention programs.

12. Describe interventiondelivery mechanisms usedin the study. Thatis, how was the interventiondelivered (e.g., at home, by

communitygroups, as part of antenatalcare, through mobile clinics,atImmunization clinics, withgrowth monitoring)?

N/A


N/A


N/A

15. Outcome measures To be determined (project in planning phase)16. Location of Study Southern and Eastern Africa (details to be determined project in planning

phase)17. Published reports(website if available)

Not yet available


2009-2010

19. Additional Comments RENEWAL website: http://www.ifpri.org/renewal/index.htm


24/51

24



Anne S.W. Mburu, [email protected], 3 March 2006

2. Research Study Title The Effects of Multimicronutrient Supplements And FoodRations On The Nutritional Status And Health Of HIV-Positive Adults


UNICEF courtesy of funding from the Dutch Government


*Anne S.W. Mburu (PI); David L. Mwaniki Centre forPublic Health Research; Kenya Medical Research Institute,Nairobi, Kenya*formerly with CPHR-KEMRI

5. Partners in study Prof David I. Thurnham; University of Ulster at Coleraine,Northern Ireland, UK; UNICEF-ESARO

6. Duration/Timeline 2002 -2003

7. Objectives The study undertook to investigate the effect of a dailymultiple micronutrient supplement in combination with adaily food ration on the nutritional status, immunologicalstatus, epithelial integrity and general health of HIV positiveadults.

8. Rationale for study Prior to easier access to ARV, this study was undertaken tocontribute to the limited but growing knowledge base on theimpact of micronutrient and food ration interventions on thequality of life and general health and well being of adult HIV-positive men and non pregnant and non lactating womenliving in resource poor settings

9. Study question(s) 1. What are the effects of a multimicronutrient supplementon the vitamin A, iron and zinc status of HIV positiveadults.

2. What are the effects of a multimicronutrient supplementon the concentrations of CD4, CD8 subsets, selectedplasma interleukins and selected acute phase proteins.

3. What are the effects of a multimicronutrient supplementon gut epithelial integrity.4. Establish the effects of nutritional intervention on general

health and well-being.

10. Study Design Randomized double blinded and placebo controlledintervention with both arms receiving a food ration (90:10precooked maize soy blend). Micronutrient provided between1.3 and 2 X RDA of 16 vitamins and minerals.

11. Describeintervention/ inputssuch as counseling,

Participants took part for a duration of six months, within thefirst three months follow up was fortnightly, in the last threemonths follow up was monthly. Participants received a


25/51

25

food/nutrientsupplements frequencyof inputs

supply of the daily Multiple micronutrient supplement orplacebo capsules and precooked maize soy blend (UNIMIX90% maize: 10% soy) to both arms of the intervention

sufficient to cover the periods between follow up. Nutritioncounseling was provided at each follow up. ConfirmatoryHIV tests were undertaken. Participants were provided withsmall notebooks and a pen to function as diaries so that theycould ask the investigators questions and record theirthoughts on the journey, a referral notebook was alsoprovided for participants to procure treatment from theprovincial general hospital when the need arose and for acopy of the prescribed medication to be recorded for theinvestigators reference.

12. Estimated numberof subjects, eligibility

criteria and description(age, HIV status, etc.)

180 individuals recruited, 177 participated at baseline (95MMN and 82 placebo); at 3 months 95 participants (48

MMN and 47 placebo); at 6 months 48 participants(20MMN and 28 placebo)

(note: MMN multimicronutrients)

Criteria for eligibility: absence of active illness adult (18-45 years) male or non pregnant non lactating

female tested for HIV and aware of status known local address willing to participate not taking any multivitamins or mineral preparations;

not on ARVs, if diagnosed with Pulmonary Tb to have received a

minimum of two months medication prior to participatingon the study.

13. Outcome measures Changes in nutritional status were assessed between baseline,3 months and 6 months, these included changes inmicronutrient status (plasma retinol and carotenoid status);haematological status, zinc, anthropometric status.Additionally, markers of inflammation were assessed theseincluded changes in gut integrity; ESR, CRP, ACT, AGP andplasma cytokines. Immunological markers including totalwhite blood cell counts; CD4, CD8 counts and their ratios

were assessed. Changes in plasma viraemia were alsoassessed and finally a Lifestyle and QOL questionnaire wasundertaken at Baseline and subsequently at 3 and 6 months inaddition to food frequency questionnaires.

14. Location of Study Two towns in the Western Highlands of Kenya :Nakuru andNanyuki


2003: ICASA NAIROBI - KENYA BMI Changes in Food Ration and Multimicronutrient

supplemented HIV positive adults (poster): Mburu ASW,Mwaniki DL, de Wagt A, Thurnham DI, Selenje L.


26/51

26

Haematological response to Multiple Micronutrient andFood Ration Supplementation among adults living withHIV/AIDS (poster): Mburu ASW, Mwaniki DL, de

Wagt A, Thurnham DI, Selenje L.

2004: AFRICAN HEALTH SCIENCES CONGRESS

NAIROBI - KENYA Effects of Multimicronutrient Supplementation and Food

Ration on Haemoglobin and Red Cell Morphology inHIV+ Adults (Poster): Mburu ASW, Mwaniki DL,Thurnham DI, Alumasa F, Muniu E, de Wagt A

Changes in nutritional status, inflammation markers andsymptom burden of HIV+ adults receiving a multiple

micronutrient supplement and food ration (Oral): MburuASW, Mwaniki DL, Thurnham DI, Alumasa F, Muniu E,de Wagt A

2004: IVACG XXII PERU (Abstract T12) Effects of Multiple Micronutrient Supplements and a

Food Ration Interventions Among Adult Men and NonPregnant and Non Lactating Women Living WithHIV/AIDS on Micronutrient Status (Poster): MburuASW, Mwaniki DL, Thurnham DI, Alumasa F, Muniu E,de Wagt A

2005: PROCEEDINGS OF THE NUTRITION SOCIETY Micronutrients in childhood and the influence of

subclinical inflammation; Thurnham DI, Mburu ASW,Mwaniki DL, de Wagt A, (2005), Proceedings of theNutrition Society, 64 (4): 502-509

2005: AFRICAN HEALTH SCIENCES CONGRESS

EGYPT Field Experiences on a Nutrition Intervention Providing

Multimicronutrient and Food Supplements to AdultsLiving With HIV/AIDS (Oral) Mburu ASW, MwanikiDL, Thurnham DI, Alumasa F, Muniu E, de Wagt A

2006: BIOAVAILABILITY CHIANG MAI,

THAILAND Using acute phase proteins to correct plasma ferritin

concentrations enables ferritin to e used to show benefitsof iron supplementation in apparently healthy adultsliving with HIV/AIDS (poster): David I Thurnham; AnneSW Mburu, David L Mwaniki, Fred Alumasa, ErastusMuniu, Arjan de Wagt.

Subclinical inflammation may explain part of the highand low absorber phenomenon following supplements of


27/51

27

-carotene (oral): David I Thurnham; Anne SW Mburu,David L Mwaniki, Fred Alumasa, Erastus Muniu, Arjande Wagt

NB: name underlined indicates presenting author.


Dissemination undertaken and Final report submittedto UNICEF; September 2004

Plasma acute phase protein concentrations tointerpret nutritional status in people living withAIDS; David I. Thurnham; Anne S.W. Mburu; DavidL. Mwaniki; Erastus Muniu; Fred Alumasa; Arjan deWagt (publication under review)


Study approved by the Scientific Steering Committee andEthical Review Board of KEMRI and the Contract ReviewCommittee UNICEF.

18. Describeintervention deliverymechanisms used in thestudy. Thatis, how was theintervention delivered(e.g., at home, bycommunitygroups, as part of

antenatal care, throughmobile clinics, atImmunization clinics,with growthmonitoring)?

Intervention delivered through community based clinic,offering psychosocial support in addition to communityeducation and interventions on cost effective methods ofinfection control. Participants visited clinic at recruitmentand the intermittent follow up appointments assigned by thestudy investigators, but could visit between appointments ifand when the need arose.

19. What process data,if any, were gatheredon how well thedeliveryworked (e.g., coverage,attendance, operational

feasibility,distribution)?

Pill counts were undertaken and recorded so as to monitornutrition supplement compliance at each follow up visit.Register of food ration provided was maintained to monitoruptake and compliance as well as facilitate deliverymechanisms. Register and calendar kept of expected visitsand any additional/unexpected visits noted.


28/51

28



Fathia Abdalla, Senior Nutritionist, UNHCR HQ, Geneva.Tel: + 41 22 739 8932Fax: +41 22 739 73 66

Paul Spiegel (MD, MPH), Senior HIV Technical OfficerUNHCR HQ, GenevaTel +41 22 739 8289Fax: 41 22 739 7371

Gebrewold Petros(Dr), UNHCR Liaison Officer to UNAIDS,UNHCR, Pretoria, South Africa.tel: +27 12 354 8315, fax: +27 12 354 8390

2. Research Study Title Implementation of program strategies to integrate HIV/AIDSand nutrition activities in refuge settings in Uganda and inZambia.


UNHCR, BPRM, UNICEF and WFP.Medium


United Nations High Commissioner for Refugees(UNHCR) Projects are being implemented by implementingpartners in both countries.

5. Partners in study UNHCR, UNICEF, WFP, The Governments of Uganda and ofZambia, and UNHCR Partners including GTZ, AAH, ZambiaRed Cross Society

6. Duration/Timeline 08 months as of September 2005

7. Objectives a. Implement different program strategies for integration ofHIV/AIDS and nutrition activities in different refugee settingsb. Evaluate and write lessons learned / better practicedocument / on how program strategies actually worked in reallife situations.

8. Rationale for study The rationale for the study is the recognition that humanitarianassistance presents many opportunities for interventions toreduce vulnerability to HIV/AIDS, as well as to mitigate theeffects of the illness on health, nutrition and food securitystatus of affected families. Refugee situations createopportunities for HIV/AIDS activities to be integrated intotraditional food and nutrition programs.

9. Study question(s) The United Nations High Commissioner for Refugees(UNHCR), the World Food Program (WFP) and the UnitedNations Childrens Fund (UNICEF), in collaboration with therespective governments of Uganda and of Zambia, hasundertaken an initiative in 2003 and developed a program


29/51

29

manual, entitled Program Strategies for Integration ofHIV/AIDS, Food and Nutrition Activities in Refugee Settings.

What are best practices and lesson learned from

implementation of the identified set of programming strategiesfor integrating HIV/AIDS, food and nutrition activities inrefugee settings?

10. Study Design Prior assessment of the refugee settings, followed by selectionof feasible strategies and implementation through animplementing partner (IP) in Uganda and through consultancyassistance and an IP in Zambia.

11. Describeintervention/ inputssuch as counseling,food/nutrient

supplements frequencyof inputs

The existing feeding programs, general food distributionmechanisms and the health care system are utilized.Demonstration gardens, training and IEC development takeplace locally.

District health services and IPs working under health,community services and agriculture are involved.Coordination with partners and national officials, communitymobilization activities, nutrition education and condompromotions are carried out.

Monthly reports are shared at monitoring and coordinationmeetings, giving opportunity for discussion and immediatesupport.



.

1. Refugee populations where field testing occurs,especially women and children who are particularlyvulnerable (direct beneficiaries).

2. Local / host population where in integratedprogrammes, such as those in Uganda, benefit aswell

3. Other refugee populations, UN agencies, NGOs andGovernments (indirect beneficiaries)

The total numbers of refugees in both countries who arebenefiting from these projects are more than 57,174. Of these28,729(50.2%) are females and 11,327 (20%) are children

under the age of 5. The local / host population as well as otherrefugee populations, UN agencies, NGOs and Governmentswill be the indirect beneficiaries.

13. Outcome measures Performance as well as impact indicators are developed tomonitor the courses and evaluate the impacts of the projects.Monthly reports and regular updates will be compiled andshared with all partners. Joint field monitoring missions areconducted at least twice to each of the project sites. Initialassessments, consultancy reports, monitoring reports and end-project evaluations will establish the success stories.


30/51

30

14. Location of Study Kyaka II refugee settlement in Northern Uganda, Kala andMwange refugee camps in Northern Zambia

15. Published reports


Not yet; however, monthly reports and progress updates are

available. No web site is available yet.16. Expected date offinal report/publications

Second quarter of 2006


---


31/51

31



Dr. Robert Kabumbuli, Department of Sociology,Makerere University, P. O. Box 7062 Kampala,Uganda. 6th March 2006

2. Research Study Title Land ownership and food security in Uganda: AStudy of the use and control of land amonghousehold of women affected by HIV/AIDS infour districts


IFPRI - $42,000

4. Name ofOrganization and

PrincipalInvestigator(s)

Makerere University, Department of SociologyDr. Robert Kabumbuli

5. Partners in study National Council of Women Living With HIV/AIDS

6. Duration/Timeline One Year

7. Objectives Establish the relationship between HIV/AIDSand property ownership/control, and foodsecurity.

8. Rationale for study In order to bring about an increase in theresponsiveness of local, national interventionprogrammes to the problem of landinsecurity/loss among women affected by

HIV/AIDS. Local communities will begalvanised to formulate local interventions tosafeguard their interests in family propertybecause they are often unable to access or affordnational level interventions.

9. Study question(s) How does the onset of ill health and death (of themale spouse) influence the ownership/controland use of family property especially land? Whatare the intervening factors/variables in thechange of land ownership when a household isexperiencing HIV/AIDS? What interventions are

in place to address the problem of property loss,and what improvements can be made to theseinterventions?

10. Study Design Focus group discussions and key informantinterviews with local communities, leaders and staffof local organisations, and policy makers. Ahousehold questionnaire will provide quantitativeindicators.


Communities will be helped to formulate locallyappropriate interventions to address the problem ofland loss among women affected by HIV/AIDS.Interventions will be developed in a participatory


32/51

32


way from the data of the study.

12. Describe

intervention deliverymechanisms used in thestudy. Thatis, how was theintervention delivered(e.g., at home, bycommunitygroups, as part ofantenatal care, throughmobile clinics, atImmunization clinics,with growth

monitoring)?

Interventions formulated in the study will be

implemented by communities on a self-help basis,but will seek legitimation from the local governmentby involving the local officials in the study.

13. What process data,if any, were gatheredon how well thedelivery worked (e.g.,coverage, attendance,operational feasibility,distribution)?

----

14. Estimated numberof subjects, eligibilitycriteria and description

(age, HIV status, etc.)

600 respondents for the quantitative assessment. Ofthese, half will be a control group. Sample will bedrawn from four districts in equal proportions. Main

study sample will be women with HIV/AIDS andbelong to farming household, or have lost a spouseand belong to farming households. The controlsample will be of women in farming households notknown to be affected by HIV/AIDS. The qualitativesample will include local leaders and opinion leaders,staff of NGOs and CBOs, legal experts, policymakers.

15. Outcome measures Data will be gathered on socio-economic, demographiccharacteristics of households. Data will also be gathered onthe influence of variables such as tenure systems, inheritancesystems, etc. Land use characteristics will also be

documented and related to the independent variables.Qualitative and quantitative indicators will be used to helpcommunities formulate viable interventions to prevent loss ofproperty among women households affected by HIV/AIDS asa measure for food security.

16. Location of Study Four districts of the country; one district representingeach of the four regions of the country. Mbararadistrict in the western region, Luwero district incentral region, Tororo district in eastern region, andLira district in northern region. Three sub-countieshave been selected in each district.


33/51


34/51

34



Susan Thurstans, Action Against Hunger Malawi, tel:+2659960499, email: [email protected] (Nuria Salseresponded)

2. Research Study Title A pilot programme to assess the impact oftreating acutemalnutrition on mortality in adults and adolescentsstarting ARV therapy in Malawi


UN consortium: WFP, Unicef, WHO, FAO, UNAIDS46,000 USD



Action Against HungerSusan Thurstans

5. Partners in study Malawi Ministry of Health

6. Duration/Timeline 1 year May 2004 April 2006

7. Objectives 1. To provide supplementary feeding to all malnourishednew ART patients in six pilot centres

2. To provide knowledge and skills to people living withHIV taking ART and their caregivers or guardians foreffective nutrition management of infections, conditionsand drug side effects

3. To compare the response of people taking ART receivingnutritional support with CSB mixed with oil and no

nutritional support (in the future this result will becompared with the one of ART clinics distributingplumpy nut).

4. To monitor the effectiveness of providing therapeutic andsupplementary foods to existing patients takingantiretroviral therapy, and its impact on morbidity,mortality and adherence

8. Rationale for study The scale up of ART in Malawi is well under way.Currently 59 centres are providing ART. The

cumulative number of people that have been started

on ART is 17,601 up to March 2005. Of these 81%

are alive and on ART, 8% have died, 7% havedefaulted or are lost to follow up,


35/51

35

of these patients died in the first three months of

initiating therapy. It is unknown whether this is due

to poor nutritional status, or opportunistic infectionsthat are difficult to diagnose such as disseminated

TB. It is known that malnutrition is highly prevalent

amongst HIV infected adults and children. There is

therefore, a need to assess the impact of nutritional

treatment and support to people living with HIV on

morbidity and mortality. Currently in Malawi

therapeutic and supplementary feeding is targetedlargely at children. In March 2004 the Ministry of

Health, UNICEF, UNAIDS, WFP, WHO and FAO,

formed a working group on HIV and nutrition. ActionAgainst Hunger was also invited to take part in this

group. Terms of reference were written for a

consultancy on the need for nutritional support to

people taking ART. The main findings from this

consultancy and the working group were the need for

a structured approach to a nutrition component

consisting of nutrition counselling, treatment foracute malnutrition, and food security and income

generating activity interventions for patients on

ART.

At the same time, a decision was made by the Ministry ofHealth to purchase F75, F100, and plumpy nut therapeuticfeeds for acutely malnourished adults taking ART, using theART clinics as a point of entry. The ministry of healthMalawi has plans to integrate nutrition interventions into thenational scale up of ART. Nutrition interventions will bebased largely on the stage of infection. For those people whoare symptomatic, interventions will focus on nutritionalcounselling, and therapeutic and supplementary feeding forthose who fit into the criteria set by the ministry of health.

Therapeutic and supplementary feeding before and duringinitiation of ART may help to improve a patients toleranceand adherence to HAART, and improve nutritional status.

9. Study question(s) What is the impact of providing therapeutic andsupplementary feeding to acutely malnourished HIV positivepatients, on morbidity, mortality and quality of life, and whatare the appropriate indicators in Malawi

10. Study Design Pilot intervention

11. Describeintervention/ inputssuch as counseling,

All patients staring ARV therapy will be assessedanthropometrically by a health surveillance assistant. Thosereaching the criteria for severe malnutrition will be treated


36/51

36

food/nutrientsupplements frequencyof inputs

with 520g of RUTF per day. Those reaching the criteria formoderate malnutrition will receive 9kgs of CSB and 1 litre ofoil per month. All patients including those who are not

malnourished will receive nutrition counselling. Patients arefollowed up at baseline, 2 weeks, and then monthly.


An estimated 450 patients will be recruited onto the pilotprogramme. Patients should be HIV positive and newlystarting ARV therapy, with a BMI


37/51

37

No. 14Compilation of Operations Research on Food/Nutrition and HIV and AIDS


Valid International: Steve Collins and Paluku [email protected]

steve_s [email protected] March 2006

2. Research Study Title Acceptability and effectiveness of nutrition support with a

Chickpea-Sesame basedReady-to-Use-Therapeutic Food

(CS-RUTF) in chronically sick adults delivered through ahome based care (HBC) programme.


Valid International



Valid International,Steve Collins, Paluku Bahwere

5. Partners in study Nkotakhota AIDS Support Organisation (NASO) and SalimaAIDS Support Organisation (SASO), Concern Worldwide

6. Duration/Timeline Started in May 2005 and completed in November 2005,publication expected in 2006

7. Objectives 1. Assess the capacity of HBC organizations in Malawito include provision of CS-RUTF to malnourishedsymptomatic HIV positive adults in their activities.2. To assess the acceptability and impact of CS-RUTFon activity performance, nutritional status and HIVservices uptake for malnourished HIV adults prior to

commencing or at the time of commencing antiretroviraltherapy (ART) in Malawi.

8. Rationale for study 1. In Malawi, mostly in remote areas, HIV is suspectedwhen the patient is already very sick and wasted. Thesepatients are not currently eligible for ART because oftheir poor status as the ART clinics require the eligiblepatient to be ambulatory and to be stabilized prior tostarting ART.2. Currently in Malawi hospitals do not have thecapacity to provide inpatient care to all those in need ofstabilization prior to commencing ART.

3. CTC offers several important opportunities tointegrate nutrition support with HBC and to supportwider home-based initiatives to address malnutritionassociated with HIV/AIDS.In order to strengthen the evidence base of theeffectiveness of home-based nutrition management andthe impact of appropriate food supplementation on thenutritional and clinical status of HIV-infectedindividuals and to monitor the impact on coverage anduptake of HIV services.


38/51

38

9. Study question(s) 1. Acceptability of CS-RUTF2. Capacity of HBC to deliver home-based nutrition supportusing RUTF

3. Benefits of the intervention on health, nutrition and qualityof life (activity performance) of HIV-infected individuals.

10. Study Design Observational Non randomized


All patients received CS-RUTF (500 g/day), cotrimoxazole,VCT and nutrition counseling.

12. Estimated numberof subjects, eligibilitycriteria and description

(age, HIV status, etc.)

Total 56 patients.Eligible patients were clients of the participating AIDSsupport organization who were chronically ill, adults (above

18 years) and had BMI


39/51

39

No. 15Compilation of Operations Research on Food/Nutrition and HIV and AIDS


Valid International [email protected][email protected] March 2006

2. Research Study Title Integrating HIV services into a Community Therapeutic Care(CTC) programme in Malawi: an operational research study


Bureau for Africa, Office of Sustainable Development of theUnited States Agency for International Development(USAID) and Food and Nutrition Technical Assistance(FANTA)


Valid International:Corresponding author: Steve Collins

5. Partners in study Paluku Bahwere, Marthias Chimeteleni Joshua, Kate Sadler,Caroline Grobler-Tanner, Ellen Piwoz, Saul Guerrero

6. Duration/Timeline To start April 2006 for one year7. Objectives To assess the uptake of HIV testing and the impact of a

Community Therapeutic Care (CTC) programme on therehabilitation of severe acute malnutrition (SAM) in HIV-infected children.

8. Rationale for study Previous research in Malawi, as well as in other areas whereHIV is highly prevalent, indicates that 30% or more ofchildren admitted to Nutrition Rehabilitation Units (NRU) areHIV-positive. Studies have shown that severelymalnourished HIV-infected children can achieve an adequateweight for height, although recovery times are significantlylonger and mortality is much higher compared to HIV-uninfected children. However, the majority of HIV-positivechildren in Africa never receive any nutritional care eitherbecause their status is not known or because their care-givers(often HIV infected themselves) are unable to bring them tohospital or remain with them for extended periods.

9. Study question(s) To assess the feasibility of treating severely malnourishedHIV-positive children in the community rather than ininpatient NRUs.1. Can CTC be used as an entry point for providing HIVtesting and treatment referral.2. Are the CTC protocols effective in rehabilitating HIV-positive children.3. Can proxy indicators be identified for paediatric HIV thatcould be used in communities where diagnostic testing is notavailable.

10. Study Design A prospective and retrospective community-based cohortstudy


Voluntary HIV testing and counseling for caregivers andchildren offered, and basic medical care, including antibioticsfor bacterial infections, de-worming, vitamin Asupplementation, malaria prophylaxis and treatment, anaemia


40/51

40


treatment, and Ready-to-use Therapeutic Foods (RUTF) forcommunity-based nutrition rehabilitation



Children 0-59 months with severe acute malnutrition (SAM):

indicated by weight-for-height (WFH)


41/51

41

No. 16

Compilation of Operations Research on Food/Nutrition and HIV and AIDS1. Your Name, ContactInformation & Date

Valid International [email protected][email protected] March 2006

2. Research Study Title Moyo RUTF Study: A randomised controlled trial to comparethe efficacy of three new formulations of Ready-to-Use

Therapeutic Food (RUTF) in the treatment of severe acute

childhood malnutrition (HIV positive and HIV negative

children)


Valid International


Valid International: Marko Kerac, Steve Collins,

5. Partners in study Kate Sadler, James Bunn, Prof Joseph Mufutso Bengo,Andrew Seal, Prof Andrew Tomkins

- Institute of International Child Health, UK- College of Medicine, Blantyre, Malawi

6. Duration/Timeline To start April 2006 for one year

7. Objectives To investigate the efficacy of three new RUTFs in thetreatment of SAM in both HIV +ve and ve children admittedto Moyo Therapeutic Feeding Centre (TFC) at QueenElizabeth Central Hospital, Blantyre, Malawi.

8. Rationale for study Ready-to-Use Therapeutic Foods (RUTF) are a keytechnology which facilitate the outpatient treatment of severeacute malnutrition (SAM). They have been central to thedevelopment of Community-based Therapeutic Care (CTC), apublic health approach to SAM which is rapidly gainingpopularity internationally. The high cost of the Plumpynut,the reliance on one type of RUTF alone, and the dangers ofAflatoxin contamination from groundnuts are importantbarriers to the success and wide uptake of CTC. To beeffective, CTC programmes require appropriately formulated,cheap and readily available sources of RUTF.

9. Study question(s) 1. To compare the clinical and nutritional efficacy of a newformulation, low-milk/chickpea-based RUTF against thecurrently used, high-milk/peanut-based locally madePlumpynut in the treatment of SAM2. To compare the clinical and nutritional efficacy, ofSynbiotic-enhanced RUTF with standard RUTF during thetreatment of SAM (HIV +ve and ve children).

10. Study Design Randomised controlled study


Children enrolled in the study will be randomly allocated to :1. Group 1 :(Control group) - Locally made high-milk/peanut-based Plumpynut RUTF2. Group 2: New low-milk/chickpea-based RUTF


42/51

42


3. Group 3: High-milk/peanut RUTF mixed with Synbioticforte 2000.4. Group 4: Low-milk/chickpea-based RUTF mixed with

Synbiotic forte 2000.Fortnightly outpatient review of clinical progress andanthropometry and further supplies of RUTF given.


Initial pilot study of 30 children to assess acceptability andside effects, followed by 1200 SAM children: 300 assigned toeach groupRecruited from Moyo House Malnutrition Unit phase 2rehabilitation phase once appetite is returning, oedemareducing to at least ++ or below and the child is clinicallystable and requires no further inpatient care

13. Outcome measures Number cured (weight gain to 80% weight for height);mortality, rate of weight gain, number of days with diarrhea,

length of stay, default rate, number of excess illness episodes,body composition (skinfold caliper measures), tolerance toRUTF

14. Location of Study Moyo House Therapeutic Feeding Centre (TFC) at QueenElizabeth Central Hospital, Blantyre, Malawi


NA


Results will be presented at nutrition and medical meetingsin Malawi and in other countries and published in anappropriate medical publication Results: after April 2007


N/A


43/51

43



Paul BukulukiE-mail: [email protected]

2. Research Study Title Gender dimensions in food/nutrition security and HIV/AIDS inInternally displaced peoples camps in Uganda


RENEWAL/FORD Foundation


Makerere University, Faculty of Social Sciences

Paul BukulukiStella Neema

5. Partners in study Save the ChildrenUganda, Uganda Red Cross Society

6. Duration/Timeline One year and a half

7. Objectives To find out womens understanding and experience of food insecurity andthe risks that result from coping with the problem in IDP camp settings;

To examine the impact of armed conflict and displacement on peoplesperception of the risk of HIV infection and the influence of this perceptionon behavioural responses to HIV/AIDS interventions;

To assess the gender responsiveness of existing HIV/AIDS and foodsecurity strategies/policies in addressing HIV/AIDS and nutrition needs ofIDPs;

To identify and analyze the strengths and resources that exist at theindividual, household, community and institutional level that help tominimize vulnerability to food insecurity and associated risks of HIVinfection especially among women and girls in IDPs;

To use the findings and experiences of this action research process toenhance policy dialogue, advocacy and programming in respect tofood/nutrition insecurity and HIV/AIDS in situations of armed conflictand displacement

8. Rationale for study Gender issues; access to resources, control over resources (food, money, skills,

information, basic services etc.), gender roles, power relations between femalesand males on one hand, and between females and power lines/authoritystructures

Intervention - Nutritional Care Models

Documents

Transcript of Intervention - Nutritional Care Models