The AMPATH Nutrition Program Challenges and Successes

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The AMPATH Nutrition ProgramChallenges and
Successes

• USAID-AMPATH Partnership
• Eldoret, Kenya

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• Academic
• Model for the
• Prevention
• And
• Treatment of
• HIV/AIDS

• Initiated in November 2001
• 18 care sites in western Kenya
• Catchment population 2 million
• HIV prevalence 2 30
• gt70,000 patients enrolled 55,000 in care,
  25,00 on cART

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Food insecurity at AMPATH sites
30
45
30
20
80
30
50
40
20
50
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AMPATH Nutrition

• Nutrition assessment, education and counseling
• Food prescription
• Food distribution
• AMPATH HAART n Harvest Initiative (HHI) farms
• Community-based therapeutic feeding (CTF) program
• Infant and young child feeding
• Nutrition Information System

Mamlin et al. American Journal of Public Health
(In press)
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Food Support

• Ration Food given to meet 75 RDA
• Duration 6 - 9 months
• Beneficiaries All household members
• Food sources
• WFP 30,000 beneficiaries
• USAID 2,000 beneficiaries
• HHI farms 8 tones of vegetables weekly
• Food types Maize, pulses, oil, CSB,
  Ensure Vegetables, milk, eggs, Instamix
• Abbott Instamix

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Success food support works
CD4 Response Food vs. Non-Food

• Nutritional support allows patients who start out
  with relatively lower CD4 and BMI to catch up
  with other patients after 9-12 months of cART

Chakravarty et al. IAS, 2008
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Success food support works
BMI Response Food vs. Non-Food

• Non-food recipients who start out with relatively
  low CD4/BMI are not able to catch up- they
  continue to have significantly worse outcomes
  after 12 months (p 0.004)

Chakravarty et al. IAS, 2008
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Success food support works

• Community-based therapeutic feeding (CTF)

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Challenges

• Demand not yet satisfied
• High levels of food insecurity
• Endemic poverty levels
• Large number of orphans and vulnerable children
• 10,000 in care
• Additional 34,000 awaiting enrollment

• Late patient presentation
• Might be linked to stigma
• Patient survival reduced

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Challenges

• Logistical
• The right type and amount of food needs to be
  taken to all sites multiple times every week
• Food storage and preservation
• Wilting of vegetables
• Distances from distribution centers and patient
  homes may be a hindrance to food collection
• Sustainability
• Dependence on food support
• Unable to wean off 30 of our food recipients
• Recurrence in wasting disease after weaning

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Some solutions

• Enterprise development and management
• Family Preservation Initiative (FPI)
• Skills and business education
• Microfinance
• Agricultural and business co-operative societies
• Agricultural extension services
• Low cost, high production farms
• Supply fertilizer
• Double HHI food production
• Early HIV diagnosis Home Testing and Counseling

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Conclusion

• Adequate nutrition key to successful ART
• Challenges to nutritional support abound but,
  with proper planning, it is possible to wean the
  majority of beneficiaries off support
• Hunger can be conquered BUT only if poverty is
  addressed simultaneously

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Acknowledgements

• Moi University School of Medicine
• Moi Teaching and Referral Hospital
• Indiana University School of Medicine
• World Food Program
• Abbott Laboratories
• This program is supported in part by a grant to
  the USAID-AMPATH Partnership from the United
  States Agency for International Development as
  part of the Presidents Emergency Plan for AIDS
  Relief (PEPFAR)
• International Epidemiologic Databases to Evaluate
  AIDS (IeDEA) East Africa
• Appropriate Grass Roots Intervention (AGRI)

Moi Teaching and Referral Hospital
East Africa
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• Abraham M. Siika
• Moi University School of Medicine
• USAID AMPATH Partnership
• P. O. Box 4606 30100 Eldoret, Kenya
• Email amsiika_at_africaonline.co.ke
  asiika_at_iupui.edu