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Kenya[2004-Present] FANTA—and now FANTA-2—has been working with USAID, the President’s Emergency Program for AIDS Relief (PEPFAR), the Government of Kenya's National AIDS/STI Control Programme (NASCOP) and other partners to integrate food and nutrition into HIV care and treatment through a multi-pronged approach: national guidelines, training and counseling materials, the introduction of nutrition into community-based HIV care services, the integration of nutrition into the national monitoring and evaluation system, and a randomized targeted evaluation to examine the impact of food supplementation. FANTA-2 is also supporting USAID/Food for Peace (FFP) in exploring and developing gold-standard practices for exit strategies for Title II programs. Nutrition and HIV Strategies: FANTA worked with NASCOP and UNICEF to develop and disseminate a national nutrition and HIV strategy. The Kenya Nutrition and HIV/AIDS Strategy 2007-2010 seeks to mainstream nutrition interventions by sensitizing policymakers about the critical role that food and nutrition security plays and advancing nutrition and HIV/AIDS as a priority on the health agenda. The strategy also seeks ways to integrate nutrition interventions into HIV/AIDS policies and vice versa.In addition, at NASCOP’s request, FANTA-2 provided input on nutrition to the Kenya National AIDS Strategic Plan III (KNASP III), the framework for the national response to HIV. FANTA-2’s efforts helped ensure that KNASP III included key nutrition and HIV activities that are aligned with NASCOP’s nutrition and HIV strategy and helped strengthen efforts to seek funding for the activities from government and key donors. National Guidelines on Nutrition and HIV: FANTA worked with NASCOP and UNICEF to develop and disseminate the Kenya National Guidelines on Nutrition and HIV/AIDS, which establish a consistent set of nutrition recommendations for PLHIV, and describe actions that service providers need to take to provide nutrition care. FANTA-2 is supporting NASCOP in reviewing and updating the guidelines to include information on initiating a Food by Prescription program, such as targeting using entry and exit criteria and key messages for using the food. Nutrition and HIV Training Materials: To strengthen HIV service providers’ capacity to provide effective nutrition care and support, FANTA worked with NASCOP to develop a trainer manual and trainee tools for a national training course on nutrition and HIV. Nutrition Management in Comprehensive Care Centres in Kenya: A Trainer's Manual and Nutrition and HIV/AIDS: A Toolkit for Service Providers in the Comprehensive Care Centres are intended for service providers in Comprehensive Care Centres (CCCs), where HIV patients are treated. FANTA also trained more than 200 CCC service providers in using the training course. In addition, FANTA-2 is helping to adapt community training materials on nutrition and HIV for home-based care providers and community health workers. Nutrition and HIV Counseling Materials: FANTA, NASCOP and other partners developed counseling materials that focus on the nutritional needs of PLHIV. Specific topics included improving dietary intake, nutritional management of symptoms and the nutritional implications of antiretrovirals and other drugs. FANTA also worked with NASCOP to disseminate the materials and orient service providers in their use. Targeted Evaluation of Food Supplements: FANTA and the Kenya Medical Research Institute (KEMRI) conducted a randomized controlled evaluation to investigate the impact of food supplementation on the nutritional and clinical status of malnourished adult antiretroviral therapy (ART) clients and malnourished adult pre-ART clients. The study took place at six HIV care and treatment facilities in Kenya and compares the nutritional and clinical outcomes of clients receiving nutrition counseling alone with clients receiving nutrition counseling and a fortified, nutritious blended food. Food and Nutrition Implications of ART Programs: FANTA conducted an assessment of the food and nutrition needs of ART clients, gaps in program capacity, and client and provider perceptions about the role of food and nutrition in ART. The assessment was conducted in 13 public, private and Mission health care facilities in Kenya and included NGOs and PLHIV networks. Assessment findings and recommendations are documented in the report, Food and Nutrition Implications of Antiretroviral Therapy in Kenya: A Formative Assessment. Review of Kenya’s FBP Program: Funded by USAID/Kenya and the USAID Bureau for Global Health Offices of HIV/AIDS and Health, Infectious Disease, and Nutrition, FANTA developed the Review of Kenya’s Food by Prescription Programme. The report examines the program’s operation and effectiveness, focusing on specific issues, such as the duration of food supplementation, loss to follow-up among clients, changes in client nutritional status and the food delivery system. Exit Strategies in Title II Programs: FANTA-2 is exploring the effectiveness of exit strategies in Title II programs in Kenya, Bolivia and Honduras, where the programs are phasing out. The study’s results will help future programs incorporate exit strategies into their designs to ensure their impact is sustained after the programs end. FANTA-2 is also documenting the exit strategy approach and implementation of the Title II programs in India, which will contribute to this exercise as well as to global knowledge about exit approaches. M&E Systems for Nutrition and HIV: FANTA helped strengthen M&E systems for the food and nutrition components of Kenya’s national HIV response by supporting NASCOP. FANTA’s work included identifying indicators, developing data collection tools, integrating data collection and analysis approaches into key monitoring systems and helping to develop the NASCOP nutrition register for service providers to use to collect data from clients. Promising Practices in Nutrition, Food Security and HIV Programming: The Regional Centre for Quality of Health Care (RCQHC) in Uganda and FANTA reviewed nutrition, food security and HIV programs in Kenya, Malawi, Tanzania, Uganda, and Zambia to identify and document promising practices to help understand what works, replicate successful approaches and incorporate lessons into programs. The findings are available in the report, Nutrition, Food Security and HIV: A Compendium of Promising Practices. Agriculture-Based Livelihood Strategies of PLHIV: FANTA worked with a Family Health International (FHI) project, Regional Outreach Addressing AIDS through Development Strategies (ROADS), in the border town of Busia, which straddles Kenya and Uganda, to review and document agriculture-based livelihood strategies that HIV-affected households and communities are adopting. FANTA documented results and lessons from the process, including approaches that were effective at strengthening livelihoods, in the report Strengthening Agricultural Technologies Among People Living With HIV: Lessons Learned in the Border Towns of Busia, Kenya and Busia, Uganda. FANTA helped strengthen PLHIV cluster livelihood activities and enhanced their access to new opportunities, including expanding successful livelihood practices to other PLHIV clusters in the ROADS project.
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