1. The AMPATH Nutrition Program Challenges and Successes USAID-AMPATH Partnership Eldoret, Kenya

2. 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% – >70,000 patients enrolled; 55,000 in care, 25,00 on cART

3. Food insecurity at AMPATH sites 50% 40% 30% 20% 30% 80% 20% 45% 50%

4. 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)

5. 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

7. Success: food support works 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 CD4 Response: Food vs. Non-Food Chakravarty et al. IAS, 2008

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

9. Success: food support works Community-based therapeutic feeding (CTF)

10. 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

11. 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

12. 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

13. 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

14. 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 President’s 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

15. Abraham M. Siika Moi University School of Medicine USAID – AMPATH Partnership P. O. Box 4606 – 30100 Eldoret, Kenya Email: amsiika@africaonline.co.ke; asiika@iupui.eduamsiika@africaonline.co.keasiika@iupui.edu