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

Refugee participants enrolled in an antiretroviral therapy (ART) programme
may be poor and food-insecure, and unable to consume a nutritious diet,
especially if they are not receiving a full ration. Refugees enrolled in a home-based care
programme may already be receiving a supplementary ration (see integrated programme
strategies 6 and 15). If they are not enrolled in a home-based care programme
but are regularly taking ART, a supplementary ration combined
with nutrition education may increase the effectiveness of the treatment.
What does this integrated programme strategy aim to achieve?
Provision of a supplementary ration to PLWHA taking antiretroviral therapy aims to
increase the effectiveness of the treatment in suppressing the virus and promoting disease-free
survival, by boosting the ill person’s strength, nutritional status and overall
health and immune function. In addition, a number of antiretroviral drugs must be taken
with food. Common side-effects include nausea, vomiting, diarrhoea and appetite suppression.
Antiwasting medications must be accompanied by increased energy intake. Inability to
consume a proper diet while on ART can lead to painful side-effects, reduce the medications’
efficacy, and promote drug resistance.
How would this integrated programme strategy be implemented?
Institutional collaboration and coordination. Health staff must collaborate with food distribution
staff and government to develop protocols for supplementary feeding with ART. Options
being considered by the international community include supplementary tablets, bulk
commodities, prepared foods (e.g., biscuits or formula). Factors to consider in the decision
include cost, likely adherence by participants and intrahousehold sharing.
Emphasis on participatory and community-led approaches. Refugee communities may have
traditional beliefs about which foods an ill person should eat, and such beliefs may influence
how nutritional supplements are perceived. Congolese refugees in Zambia and Uganda accurately
identified foods rich in protein and micronutrients (e.g., eggs, fish, fresh fruits and vegetables)
as those they give to friends and family who are ill. Nutritional support should identify
and reinforce positive traditional practices about nutrition during illness.
Logistics of implementation. PLWHA taking ART should ideally be enrolled in a home-based
care programme. Additional research is needed to determine the nutritional requirements associated
with each antiretroviral drug regimen. Provision of supplementary rations to people on ART
requires an extremely stable supply of food aid commodities, as any breaks could affect patients’
health and may risk promoting drug resistance if adherence to the treatment protocol is disrupted.
Although research is continuing to determine for how long supplementary food support may be
necessary, many programmes currently being implemented are suggesting at least six months.
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Integrated Programme Strategy 16:
Integration of a supplementary ration and nutrition education
into an antiretroviral therapy programme