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Working Group on Nutrition and HIV/AidsThe Working Group on Nutrition and HIV/Aids met on Sunday 25 February 2007 (1400-1600) and on Tuesday February 27 (1600-1800) at the 34th Session of the SCN in Rome. Chair: Andrew Tomkins (ICH) Agenda (with links to the presentation materials) The Main Working Group Meeting on 27th Feb had 6 presentations. This was preceded by a small meeting on 25th Feb at which the issues of nutrition and food security and ways of working together in a more joined up way were discussed. Summaries of the 6 presentations and the slides which accompanied 4 of them are enclosed below:- 1) Andrew Tomkins – highlighted some of the achievements in the last year. There was recent data showing that Nutritional Interventions affect Disease Progression in HIV and Recovery from Severe Malnutrition in HIV infected children and adults. A recent meeting in Blantyre had brought together researchers with experience in the management of Severe Acute Malnutrition in HIV/AIDS and a report of the meeting is expected soon. There have been several meetings at which the importance of Food Security and Nutrition within HIV were more strongly recognised and within key agencies such as WHO, the PEPFAR Fund and the Clinton Foundation there was much greater awareness of the importance of Nutrition and HIV/AIDS within their policy documents. There are therefore increasing opportunities to incorporate Nutrition into HIV policies and programmes. In particular there is an opportunity for increased collaboration between the HIV specialists, who are often infectious disease clinicians, and nutritionists. This could include the establishment of a Nutrition Support Unit within National and Local HIV/AIDS committees. Such a unit could have 8 specific tasks (outlined in the slides) and could contribute to making bids for funding for Nutrition activities within HIV/AIDS, through Country Coordinating Mechanisms, during applications to the Global Fund and PEPFAR. The examples of Kenya and Malawi were given because they had both obtained finance for support of Nutrition/HIV activities from these agencies. There is a need to support other countries as they make their own applications. He also gave examples of the way that Private Industry could work to support the development of nutrition support in HIV and AIDS drawing on a number of Finance Developing Initiatives which could enhance nutrition support in HIV. There were specific opportunities for developing Ready to Use Therapeutic Foods (RUTF) for use in those with Severe Acute Malnutrition. 2) Bruce Cogill – described the changes coming about as a result of UN reform with a particular focus on providing a more effective Humanitarian Response, including Emergency Situations. This involves improved response capacity and enhanced leadership, accountability and predictability in 9 “gap” sectors/areas of response. The characteristics of the new way that responses will be made are outlined in the slides. There has been a clarification of the responsibility for specific technical and cross cutting areas. There is new work to be performed on setting standards and policies, together with monitoring and advocacy. The Nutrition Cluster will enable new ways of working at Country Level. It is envisaged that there will be added value from these greater collaboration efforts. The Nutrition Cluster programme will be rolled out in DRC, Liberia, Uganda and Somalia. During these activities there will be special focus on ways in which the Nutrition Cluster will achieve better efficiency through – Coordination, Capacity Building, Tool Development, Assessments, Eligibility criteria, Response and Supply Issues. 3) Stuart Gillespie - outlined the ways of working together to maximize impact. There are scientific and operational issues whereby HIV/AIDS, nutrition, food security and livelihoods interact, which are important in prevention, care and treatment and mitigation. In order to develop evidence based policies and programmes we need to develop a careful assessment of what we already know and what we need to know. He introduced an analytical framework to facilitate such an assessment. Among the key questions still to be resolved are - How should nutritional support be linked, where needed, to ARV therapy effectively and sustainably? There are several examples of food supplements being given with ARVs, which appear to be effective in enhancing adherence and outcomes. But how can be these be sustained, and indeed should they be sustained beyond the initial phases of treatment? At what point, and how, can longer-term food security interventions be linked to treatment? Further, how should interventions be established when the HIV-positive individual lives within a community of other people who may be affected but not themselves living with the virus? What role do food security interventions play in AIDS-sensitive social protection schemes by government? 4) Randa Saadeh – outlined the new ways that UN agencies are working together for Nutrition and HIV. This involves capacity building, development of policies and programmes, mobilising resources and developing evidence based guidelines. She gave several examples of collaboration which had made people more aware of the potential for nutrition interventions. These included the “Durban Consultation” which resulted in the important “Participants Statement”, the “Global Strategy for Infant and Young Child Feeding” and the new HIV/Infant feeding 'Framework for priority actions”. These had been produced as a result of close collaboration between UNAIDS, FAO, UNHCR, UNICEF, WHO, WFP, WB, UNFPA, IAEA. In addition there is the recent HIV and “Infant feeding - Consensus Statement October 2006” involving an even wider framework of collaboration (AED, EGF, UNAIDS, UNFPA, UNHCR, UNICEF, USAID, CDC). There are furthermore, specific examples of new, clear, evidence based guidelines, capacity building and resource mobilisation. A good example is the joint WHO/GFATM Framework for integrating food and nutrition activities and interventions into HIV policies, programmes and funding proposals" which has proved successful in raising resources and putting nutrition as part of the response to HIV/AIDS at country level. In all of these activities it has been possible to monitor the involvement of national governments and groups, showing very satisfactory results as outlined in the slides. 5) Pamela Fergusson – described several cohorts of severely malnourished children in Malawi in which the mortality rates, nutritional recovery and immune status had been measured according to their HIV status. There was a higher prevalence of HIV in urban compared with rural children and a higher mortality in HIV infected children, especially those with a low CD4 count (<15%). However not all children with severe acute malnutrition have low CD4 counts and there is an urgent need to develop clarity on the immune and clinical status of severely malnourished children that merit starting anti-retrovirals, which were not available at the time of the study presented. The place at which death occurred (most commonly in the paediatric wards) was similar for HIV infected and uninfected children, implying the particular need to improve nutritional management of severely malnourished children in the wards. In discussions following the presentation it became clear that there is an urgent need to decide when severely malnourished children should start treatment and the dose regime that is appropriate in view of the impact of malnutrition on drug metabolism and plasma levels. 6) Paluku Bawhere – described the results of the use of RUTF among severely malnourished children and adults with HIV/AIDS. Among the children in a Community Therapeutic Care programme, nearly all HIV uninfected children achieved 85% weight/height. This figure was lower in those with HIV but, despite the problems of opportunistic infection due to HIV, over half the HIV infected children achieved 85% weight/height. In addition both groups had low rates of nutritional relapse as assessed by MUAC at 11.0 cms and 12.5 cms or weight/height. HIV infected children and adults were referred to clinics for immunological assessment and treatment with anti-retrovirals as available. He also described a cohort of severely malnourished adults with HIV who were given 3 months nutritional support – provided by 500 g /day of locally produced RUTF (Chickpea-Sesame recipe). This provided 2600 kcal/day and 70g protein/day. There were very satisfactory rates of weight gain and this was accompanied by high rates of recovery from being bed-ridden and being too ill to walk or work. Indeed a high proportion of HIV infected adults given this supplement were able to get back to work. This programme is now being linked with food production by providing payments for producing the basic commodities for the RUTF (peanuts and oil) such that RUTF is now produced at a good commercial rate by the very people who had previously benefited from it. During the presentations and during informal meetings held after the main 2 hour session of the WG it was suggested that there should be a mid –year meeting to discuss the impact of RUTF in HIV/AIDS. Several NGOs with considerable experience of treating HIV infected adults and children offered to help run such a meeting. There was very favourable comment on the SCN website on Nutrition and HIV. A meeting on the Management of Severe Acute Malnutrition with a special focus on HIV was subsequently held on March 20th 2007 at the Centre for International Health and Development, Institute of Child Health, London and the results of the presentations will shortly be available on their website – www.cihd.ich.ucl.ac.uk. |
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