Cade Fields-Gardner, MS, RD, LDN, CD TCE Consulting Group

HIV-Specific Programming Considerations: The usual: general food insecurity, disease HIV uniqueness: medical, social Goals: Medical, social, economic Context-dependent: range of target populations, available services, baseline conditions and issues

Nutrition/Food-Related Needs HIV vs HIV + risk factors Lessons from infection Different risk factors and changes in nutrient needs Increases and decreases (needs and tolerances) Complications Unique and common

Examples Food by Prescription Incentive to access medical care Medical nutrition intervention Food security HIV-infected as criteria for vulnerability HIV-affected as criteria for vulnerability

HIV-Specific Examples Creating categories and training Malnourished vs adequate by what criteria? CD4+ - does it count for nutrition? Previous weight loss, significant decline in BMI What measures are associated real clinical benefit? What benefits can be achieved? Is gaining weight quickly the best thing to do? Is restoration the same as baseline?

Practice and Evidence? What lessons can we take from developed countries? Related to HIV Transferred from other conditions Macro- vs micro-modulation: priorities! What difference are needed in resource-limited settings? Considering additional criteria: social, economic in a single program Doing something vs waiting for evidence

Field Experiences HIV-related distribution in pilot programs and as a part of PVO distribution programs Isolated soy protein beverage supplemental nutrition for patients in Cape Town, RSA improved consumption of high quality protein Micronutrient-fortified dehydrated potato flakes in Zambia to improve micronutrient consumption Nutrition rehabilitation with potato flakes in Burkina Faso food basket: possible additive effect for rehabilitation

Summary HIV is chronic, inflammatory disease with very individual risk-factors, complications, and intervention needs Programming nutrition is challenging in current program settings with resource limitations Experience from pilot and project information needs to be standardized to contribute to knowledge base Experience can draw from general programs to be tested in HIV intervention settings

Summary Pilots and plans for adjustment and scale up could be included in existing and proposed programs Private-public partnerships can bring innovation and technical expertise Recommendations and requirements for may be more reasonably adopted if the reasoning is based on measurable results If micro-modulatory recommendations are to be made, there is a need to show value in this context