Food by PrescriptionImproving the Health and Nutritional Status of People Living with HIV/AIDS in Ethiopia

HIV/AIDS has become one of the world’s most serious health and development challenges. Since the first cases were reported in 1981, more than 25 million people have died of AIDS worldwide, and another 33 million are currently living with the virus. The large majority of these people lives in sub-Saharan Africa and suffers the added burden of food insecurity and malnutrition. In recent years, anti-retroviral drug therapy (ART) has been made more widely available for HIV treatment in developing countries. Although the rollout of ARTs has contributed to increased survival and has decreased the incidence of AIDS, weight loss and wasting remain the strongest predictors of mortality among people living with HIV/AIDS (PLWHA), even for those undergoing anti-retroviral treatment.

In an attempt to address this mortality, there has been a growing interest in food supplementation for PLWHA on ART. Food supplementation programs can improve adherence to medications, reduce drug side effects, and may also improve survival, recovery, and disease progression. However, thus far, very few studies have examined these relationships in resource-poor environments.

This study aims to build upon the existing—but limited—literature and will examine the effectiveness of a large-scale food supplementation program for PLWHA in a field setting in Ethiopia. In addition to the study, the project will include a capacity-building component, through which Tufts will develop a pre-service training curriculum on HIV and nutrition for Ethiopian health workers. The objectives of this project are:

  1. to examine the impact of prescribed food on survival, HIV disease progression, and recovery from malnutrition of HIV+ adult clients in Ethiopia;
  2. to examine the cost-effectiveness of prescribed food to HIV+ adult clients in Ethiopia; and
  3. to ensure that health and nutrition practitioners/managers leaving the main training institutions in Ethiopia to work in HIV support programs across the country understand the role of food and nutrition in the treatment and support of PLWHA.

Both the Food by Prescription program, which is being supported by Save the Children US in Ethiopia, and the Tufts study component began rollout in June 2010. Thus far, activities under the project have included a team trip to Ethiopia in December 2009 to share the protocols and finalize the study design with project-implementing partners. This trip included a visit to Hawassa University – the first in the country to establish both an MSc and a BSc in Applied Nutrition – to explore the potential for partnership on the pre-service training component of this project.

A second trip to Ethiopia in May 2010 ensured that data collection requirements and procedures were finalized with the Monitoring and Evaluation team in Addis Ababa, in preparation for rollout in June. In addition, further discussions with Hawassa University led to the development of a Memorandum of Understanding (MoU) and timeframe for the training activities.

This Food by Prescription program has the potential to improve both the capacity of health professionals to address the nutritional needs of PLHIV and the effectiveness of HIV care and treatment in Ethiopia. Currently, there is almost no documented program data that can help answer questions around the additional benefits to PLHIV and costs of adding food to an ART regimen nor of the successes and challenges to scaling up a program of this type. As HIV programs embrace the need for a nutrition component, there is an urgent need to “learn by doing” and the phased rollout of the FBP program in Ethiopia provides a great opportunity to do just this. This project is expected to run until at least September 2012.

This project brings together Tufts University faculty from the Friedman School of Nutrition (Professors Patrick Webb, Shibani Ghosh, Jennifer Coates, and Beatrice Rogers) and Tufts/FIC (Professor Kate Sadler and researcher Elizabeth Bontrager), with implementing partner Save the Children USA/USAID.