Interventions

There are three main types of nutrition interventions for the treatment, care and support of PLWHAs:

Counselling and care: Counselling can improve nutrition and help to maintain health. While the individual shows no symptoms, counselling may help in maintaining weight. During the later stages of the disease, it can assist with the management of problems associated with opportunistic infections. However, the success of a nutrition counselling and care intervention is highly dependent on the skills and training of the provider, which may be limited where human resources are scarce and demand is high. In addition, most points of service require individuals to travel. As a result, most do not access services until they are at an advanced stage of malnutrition.

Targeted nutrition supplementation: There are three types of targeted nutrition supplements: micronutrients, food rations to manage mild weight loss, and therapeutic feeding for rehabilitation of moderate and severe malnutrition. Multiple micronutrient supplementation at RDA (recommended daily allowance) levels is a relatively cheap intervention that does not have large logistical implications. However, the ideal content of the supplementation for PLWHAs is still unknown. Supplementary feeding may be beneficial in assisting compliance with ARV treatment, providing social support and encouraging PLWHA to access services more often. The aim of food assistance must therefore be clearly identified: is it for nutrition benefit, economic support or social support? Therapeutic feeding has been found to be effective in reversing moderate and acute malnutrition, but relapses are frequent once the patient returns to the environment that led to the malnutrition. It is also expensive. There is therefore a need to strengthen community coping mechanisms/safety nets.

Other food interventions: A number of HIV-related nutrition interventions in food aid/emergency responses and in agricultural and rural development programmes have been piloted and implemented. While some of these interventions have been evaluated, most have not. Best practice is therefore based on anecdotal evidence rather than rigorous investigation. However, there is a widespread belief that this lack of evidence should not stop implementation, since food supplementation in emergency responses and in livelihoods projects is used to strengthen human capital and to preserve assets.