Integration of HIV/AIDS activities with food and nutrition support in ...

Therapeutic feeding programmes (TFPs) provide intensive nutritional and medical
support to individuals with severe acute malnutrition. Most, but not all,
TFP beneficiaries are children. Children living with HIV/AIDS in poor countries often
become very sick before the age of five as a result of repeated opportunistic infections,
particularly diarrhoea and respiratory infections. 25 TFPs should be started on the basis
of assessments of the prevalence of severe acute malnutrition.
They should be used as an opportunity to link participating families with services for
treatment of opportunistic infections, and HIV/AIDS awareness and prevention activities
(including voluntary counselling and testing and family planning services).
If HIV is suspected in a child, testing the parents as well as the child for HIV
would help to provide more comprehensive services to the family.
What does this integrated programme strategy aim to achieve?
Health discussions between participants (caretakers and patients) and TFP staff are used
as opportunities to engage in discussions of HIV/AIDS risk and prevention in participants’
lives. These discussions empower caretakers and adult participants with skills to
prevent HIV transmission to themselves and their children, who may be engaging in highrisk
behaviours. This programme is designed to empower people to assess and reduce their
own risk of HIV exposure, and to make informed decisions about seeking voluntary counselling
and testing (VCT) services, by providing accurate, sensitive information and fostering dialogue
about HIV/AIDS.
Referral systems are established between the TFP and the health facility to support TFP
participants who decide to seek AIDS-related services, such as VCT and ART. Where VCT
services are available, participants who wish to be tested should be promptly referred to qualified
counsellors. Where a PMTCT programme is in place, women in the TFP should have the opportunity
to discuss with qualified VCT counsellors the benefits of PMTCT participation to themselves
and their future children. For breastfeeding women known or suspected to be HIV-positive,
supplemental suckling techniques can be discussed to reduce the risks of HIV transmission associated
with mixed feeding during rehabilitation. Where ART is not yet established, support may be
given to families with possible HIV infection to ensure good care and nutrition. Referral to hospital
settings can also help to ensure adequate medical care for acute and underlying conditions.
How would this integrated programme strategy be implemented?
Institutional collaboration and coordination. For infants and young children who fail to
thrive, referral to the TFP should be accompanied by assessment of indicators of HIV infection.
Where acute conditions (e.g., opportunistic infections) are present, admission to hospital may
be necessary. TFP staff should collaborate with health staff (e.g., VCT and PMTCT counsellors)
and other community resource persons (e.g., HIV/AIDS peer educators) to design and conduct
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Integrated Programme Strategy 3:
Incorporation of HIV/AIDS awareness and prevention activities
into a therapeutic feeding programme
25 Shearer WT, Hanson IC, eds. Medical management of AIDS in children. Philadelphia: Elsevier Science (USA), 2003.