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Community treatment for HIV-related malnutrition in Malawi

HIV has led to an increase in both acute and chronic malnutrition. People with HIV are prone to infections and likely to become more financially, socially and psychologically vulnerable. Community care programmes offer an effective way of treating HIV-related malnutrition as well as other aspects of the disease.

The Community Care Research Programme is a collaborative project between Valid International and Concern Worldwide. Its research team has examined the potential of an approach called Community-Based Therapeutic Care, or CTC, to address HIV-linked malnutrition.

CTC was initiated in Malawi in July 2000. Recovery rates from the first 12 programmes, which treated 9,020 severely malnourished people, showed that outcomes were well within international standards for therapeutic feeding programmes.

Instead of using therapeutic feeding centres or rehabilitation units, the approach uses a ready-to-use therapeutic food which patients can take home. The food is high-energy, contains an appropriate balance of nutrients and needs no cooking. The CTC model for severe malnutrition is similar to the home-based care which is seen as the best way to care for people with HIV and AIDS. It provides for physical care, reduction of stigma, building local capacities and promoting sustainable support for people with HIV. It could therefore be an effective way of treating malnutrition in people with HIV, although there are also some risks. These include the potential effect of high-fat, high-sugar food on the body’s uptake of antiretroviral drugs and a possibility of increasing the risk of some bacterial infections.

Findings include:

In the first 12 programmes of CTC, recovery rate was 76.5 percent, with a default rate of 10.6 percent and a death rate of 4.8 percent.
In Malawi, research has indicated that up to 35 percent of severely malnourished children were HIV-positive.
In the 2002-2003 hungry season in Malawi, 95 percent of severely malnourished children receiving the therapeutic food as outpatients reached their target weight, including 56 percent of the HIV-positive children.
CTC combines medical and nutritional treatment with home and clinic-based support for carers, and links with a variety of local agencies and structures to address the wider causes of malnutrition.
CTC decreases the barriers to treatment by decentralising treatment sites and working with communities. Using malnutrition rather than HIV as the ‘entry point’ also reduces stigma.

The CTC model contains many features that are appropriate for the care of HIV-affected people. The Community Care Research Programme is currently adapting the model to make it more suitable for this purpose in the longer term. Policy implications include:

By decentralising treatment, CTC can improve access, reduce the number of people who discontinue treatment and help HIV-affected households and communities to remain economically productive.
Implementing CTC requires decentralised monitoring and surveillance systems. These need a well planned and co-ordinated strategy linked to existing community-based programmes.
Where possible CTC works through existing health infrastructure such as maternal and child health outpatients clinics.
The trust, understanding and participation of the community are key to providing affordable long-term support for the treatment of sick people at home.

Lowering the cost of the therapeutic food is essential. Imported products are too expensive for national governments. Whilst local production with local ingredients could reduce the costs, this remains a potential limitation for sustainable CTC.

Source(s):
‘Community-based therapeutic care in HIV-affected populations’, Transactions of the Royal Society of Tropical Medicine and Hygiene 100(1), pages 6-9, by Kate Sadler, Paluku Bahwere, Saul Guerrero and Steve Collins, 2006
HINARI subscribers can access the full-text article here. Full document.

Funded by: SARA Project/Academy for Educational Development (AED)

id21 Research Highlight: 3 November 2006

Further Information:
Kate Sadler
Valid International
Unit 4
Standingford House
26 Cave Street
Oxford OX4 1BA
UK

Tel: +44 (0) 1865 722180
Fax: +44 (0) 7092 384 987
Contact the contributor: kate@validinternational.org

Valid International, UK

Concern Worldwide

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