This is a continued activity for FY2009.

The Academy of Educational Development (AED) Food and Nutrition Technical Assistance Project (FANTA)

has assisted numerous countries to formulate policies and technical guidance for HIV/AIDS and nutrition,

develop appropriate training curricula and job aides for nutrition support, and establish programs to directly

address the nutritional needs of those who are most vulnerable within HIV/AIDS care and treatment

programs. Drawing heavily on this experience, FANTA began working with USG/Vietnam, Vietnam

Administration of HIV/AIDS Control (VAAC), National Institute of Nutrition (NIN) and other USG partners in

FY2008 to identify gaps in HIV/AIDS and nutrition programming. The findings and recommendations

identified the direction for future efforts to address the nutrition and food needs of clinically malnourished

PLHIV and OVC in Vietnam and pointed to the need for more comprehensive and standardized nutrition

materials and programming. FANTA activities in FY2009 (COP08) which are targeted for adult PLHIV

include:

1) Strengthen the local capacity for leadership on nutrition and HIV. FANTA is supporting the development

of a technical working group on nutrition, food, and HIV and technical support and capacity building for the

establishment of a nutrition focal person within NIN. The technical working group (TWG) will be led by the

Government of Vietnam (GVN) through the VAAC and composed of stakeholders working in nutrition, food,

and HIV in Vietnam in the NIN. Support will ensure ownership and coordination of activities by the GVN

and provide access to expert opinion and input on nutrition, food, and HIV activities implemented in

Vietnam. Members of the TWG include representatives from VAAC, the NIN, the Consultants Administration

of Vietnam, PEPFAR, UNICEF, and a range of partners such as the Food and Nutrition Technical

Assistance II Project (FANTA-2), FHI, PACT, World Vision, CARE, Médecins du Monde (MdM), the Clinton

Foundation, Save the Children U.S., and Vietnam Cooperation with the Harvard Medical School AIDS

Initiative in Vietnam (HAIVN). The TWG will provide technical input on materials developed and activities

implemented, and assist with the development and dissemination and scale-up plans and identification of

next steps.

2) Support the development and operationalization of national guidelines on nutrition care and support of

PLHIV and HIV-positive pregnant and lactating women. There are currently no national guidelines or

protocols on nutrition care and support for PLHIV, OVC and HIV-positive pregnant and lactating women.

VAAC and NIN have requested technical support to develop national guidelines on nutrition care and

support of PLHIV. National guidelines will serve to advocate for the importance of nutrition in HIV treatment

and care, provide guidance for programs and service providers, and ensure standard messages and

approaches for nutrition care and support. The TWG also will assist in developing plans for national

dissemination of the guidelines, training program managers, trainers, and service providers in their use, and

monitoring and evaluating their operationalization.

3) Strengthen nutrition screening, assessment, and counseling in clinical and community-based services.

With the assistance of Albion Street Center (ASC), FHI is piloting nutrition screening, counseling, and

assessment tools and materials and standard operating procedures for the use of these tools and materials

by service providers and PLWHA support groups. FANTA will work with ASC, FHI and the Technical

Working group to assess the quality of data collected with these tools (e.g. anthropometric assessment of

PLWHA and OVC) in PEPFAR/Vietnam-supported sites to identify systemic inadequacies to guide the

finalization of the national-level tools and materials.

4) Technical assistance to design, implement and evaluate a food-by-prescription (FBP) program in clinic

sites. OPCs and PLWHA support groups in Vietnam currently provide limited food support for PLHIV and

OVC. Building on lessons learned in similar PEPFAR programs in Haiti, Kenya and Uganda, USG/Vietnam

will implement a Food by Prescription (FBP) program in F2009 to be an effective and replicable approach to

meeting nutritional needs of clinically malnourished PLWHA in USG programs. USG/Vietnam's Food by

Prescription strategy includes the following components: (1) clear eligibility and exit criteria, (2) skilled

nutrition assessment and counseling as a standard of care for clinical management of clients, (3) food

procurement, distribution and storage, (4) prescriptions for individual take-home therapeutic and

supplementary food products as part of clinical HIV care and treatment services, and (5) quality

improvement within the clinics so that the Food by Prescription program can be effectively integrated and

functional. FANTA is working with UNICEF, Clinton Foundation, and USG partners to forecast the amount

of food needed for therapeutic and supplementary purposes and to determine resource allocation,

geographic targeting and appropriate foods for use in the Food by Prescription program. FANTA is also

working with partners to identify appropriate foods which meets the energy requirements of clients as

determined by their nutrition status and advise on the product specifications and production standards (e.g.

GMP and safety).

There are few data available on the prevalence of severe and moderate malnutrition among PLWHA, but

health service providers at hospitals and OPCs and PLWHA support group members reported seeing high

levels of malnutrition among their clients. Identifying the causes of malnutrition as a result of HIV infection is

complicated by the fact that a high percentage of HIV-positive clients in urban areas are IDUs. The

provision of food and even nutrition counseling messages may not have the same outcomes with this group

as with non-drug-using PLWHA.

Results from the FBP program pilot will be used to guide scale-up. MOH approval for a national-level FBP

program and identification of a national supply chain management system must precede national-level

implementation. Implementation will be strengthened by the development of FBP guidelines on protocols,

systems, partner roles, food product specifications, quality control information, and M&E approaches and

indicators. The success of national-level scale-up of a FBP program will also depend on the availability of

trained clinical staff and monitoring and evaluation of implementation.

5). Support pre-service curriculum development and training in nutrition and HIV in nursing and medical

schools. FANTA is conducting a comprehensive assessment of how nutrition and HIV are addressed in

current nursing and medical school curricula and identification of entry points for nutrition and HIV content.

Activity Narrative: In FY2010 (COP09), FANTA will continue their support USG/Vietnam, specifically to: (1) strengthen the

national technical working group on nutrition, food, and HIV and support for a focal person within NIN; (2)

assist with specifications for procurement of appropriate therapeutic and supplementary food(s) for clinically

malnourished PLWHA patients in care and treatment programs, pregnant/lactating women in PMTCT

programs, and infants of HIV-positive women from early weaning (~6 mo) to 2 years of age; (3) provide

technical assistance to the food processing company producing the therapeutic/supplementary food(s) to

establish systems for distribution to clinic sites, inventory control, provision to patients, and record keeping

based on the Kenya FBP program experience; (4) work with VAAC, NIN, USG partners and to establish

training and QA approaches to effectively integrate and strengthen nutrition assessment and counseling

within all PEPFAR-supported care and treatment sites (including PMTCT); (5) assist the same partners to

establish guidelines and protocols for the introduction of the FBP model for clinically malnourished PLWHA,

PMTCT women and OVC in 20 hospitals and 25 health centers; (6) provide recommendations on

specifications for appropriate daily multi-micronutrient supplements for adult PLWHA, PMTCT

pregnant/lactating women and OVC whose diets are likely to be inadequate to meet basic vitamin/mineral

requirements; and (7) finalize national guidelines and protocols in nutritional care and support of PLWHA.

Finally, FANTA will share current scientific knowledge and program experience from other countries with

PEPFAR/Ethiopia and its implementing partners, particularly with regard to linking clinical nutrition support

with food security and livelihood assistance, including "wrap-arounds" with food aid and MCH/nutrition

programming, to address the longer-term food and nutrition needs of PLWHA and their families.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $180,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

This is a continuing activity for FY2009.

The Academy of Educational Development (AED)'s Food and Nutrition Technical Assistance Project

(FANTA) has assisted numerous countries to formulate policies and technical guidance for HIV/AIDS and

nutrition, develop appropriate training curricula and job aides for nutrition support, and establish programs to

directly address the nutritional needs of those who are most vulnerable within HIV/AIDS care and treatment

programs. Drawing heavily on this experience, FANTA began working with USG/Vietnam, Vietnam

Administration of HIV/AIDS Control (VAAC), NIN and other USG partners in FY2008 to identify gaps in

HIV/AIDS and nutrition programming.

The findings and recommendations identified the direction for future efforts to address the nutrition and food

needs of OVC, especially children under the age of two, born to HIV-positive mothers and identified and

linked to pediatric care and treatment, PMTCT or OVC programs. FANTA activities in FY2009 (COP08)

which are targeted for HIV-positive children include:

1) Improve the safety of feeding of infants and young children born to HIV-positive women. Ministry of

Health (MOH) policy in Vietnam encourages HIV-positive mothers to use replacement feeding for their

infants and young children. PEPFAR/Vietnam adheres to this policy in its PMTCT programming and support

services for HIV-positive mothers and their infants but recognizes the risks of sub-optimal infant feeding

practices. Anecdotal reports indicate that mixed feeding practices is high. The Centers for Disease Control

and Prevention (CDC)/Vietnam supports the provision of infant formula for 6 months to infants born to HIV-

positive women and will shortly extend this support to 18 months. In FY2008, FANTA is supporting an

assessment of infant feeding practices by HIV-positive mothers will allow PEPFAR/Vietnam to target

counseling messages, capacity building, and training to discourage high-risk infant feeding practices such

as mixed feeding and poor or unhygienic preparation, storage, and use of replacement foods. Based on the

results, counseling materials will be developed to include counseling cards, posters for clinical sites, and

take-home brochures. The materials will target other caregivers in the family as well as mothers. Following

drafting of the counseling materials, field testing, TWG review, and preparation of a dissemination plan, the

VAAC will seek MOH approval of the counseling materials before dissemination. Health service providers in

the national pediatric hospitals, PMTCT programs, and OPCs, as well as PLHIV support groups and HBC

networks, will be trained in the use of the counseling and IEC materials.

2) Strengthen the local capacity for leadership on nutrition and HIV. FANTA is supporting the development

of a technical working group on nutrition, food, and HIV and technical support and capacity building for the

establishment of a nutrition focal person within NIN. The technical working group (TWG) will be led by the

Government of Vietnam (GOV) through the VAAC and composed of stakeholders working in nutrition, food,

and HIV in Vietnam in the National Institute of Nutrition (NIN). Support will ensure ownership and

coordination of activities by the GOV and provide access to expert opinion and input on nutrition, food, and

HIV activities implemented in Vietnam. Members of the TWG include representatives from VAAC, the NIN,

the Consultants Administration of Vietnam, PEPFAR, UNICEF, and a range of partners such as the Food

and Nutrition Technical Assistance II Project (FANTA-2), FHI, PACT, World Vision, CARE, Médecins du

Monde (MdM), the Clinton Foundation, Save the Children U.S., and Vietnam Cooperation with the Harvard

AIDS Program (V-CHAP). The TWG will provide technical input on materials developed and activities

implemented, and assist with the development and dissemination and scale-up plans and identification of

next steps.

3) Support the development and operationalization of national guidelines on nutrition care and support of

HIV-positive children. There are currently no national guidelines or protocols on nutrition care and support of

HIV-affected and infected children. VAAC and NIN have requested technical support to develop national

guidelines on nutrition care and support of PLHIV. National guidelines will serve to advocate for the

importance of nutrition in HIV treatment and care, provide guidance for programs and service providers, and

ensure standard messages and approaches for nutrition care and support..

4) Strengthen nutrition screening, assessment, and counseling in clinical and community-based services for

OVC and pregnant and lactating women. With the assistance of Albion Street Center (ASC), FHI is piloting

nutrition screening, counseling, and assessment tools and materials and standard operating procedures

(SOP) for the use of these tools and materials by service providers. FANTA will work with ASC, FHI and

the Technical Working group to assess the quality of data collected with these tools (e.g. anthropometric

assessment of PLHIV and OVC) in PEPFAR/Vietnam-supported sites to identify systemic inadequacies to

guide the finalization of the national-level tools and materials.

5) Technical assistance to design, implement and evaluate a food-by-prescription (FBP) program for

children in clinic sites. Building on lessons learned in similar PEPFAR programs in Haiti, Kenya and

Uganda, USG/Vietnam will implement a Food by Prescription (FBP) program in F2009 to be an effective

and replicable approach to meeting nutritional needs of clinically malnourished children in USG programs.

USG/Vietnam's Food by Prescription strategy for children is implemented in partnership with Clinton

Foundation. Currently the program is testing the acceptability and feasibility of prescribing Plumpy' Nut for

clinical malnourished HIV-affected and infected Vietnamese children. The program also includes the

following components: (1) clear eligibility and exit criteria, (2) skilled nutrition assessment and counseling as

a standard of care for clinical management of children and pregnant and lactating women, (3) food

procurement, distribution and storage, (4) prescriptions for individual take-home therapeutic and

supplementary food products as part of clinical HIV care and treatment services, and (5) quality

improvement within the clinics so that the Food by Prescription program can be effectively integrated and

functional. FANTA is working with UNICEF, Clinton Foundation, and USG partners to forecast the amount

of food needed for therapeutic and supplementary purposes and to determine resource allocation,

geographic targeting and appropriate foods for use in the Food by Prescription program.

There are few data available on the prevalence of severe and moderate malnutrition among children in

Vietnam, but health service providers at hospitals and report seeing high levels of malnutrition among their

clients. Results from the FBP program pilot will be used to guide scale-up. MOH approval for a national-

Activity Narrative: level FBP program and identification of a national supply chain management system must precede national-

level implementation. Implementation will be strengthened by the development of FBP guidelines on

protocols, systems, partner roles, food product specifications, quality control information, and M&E

approaches and indicators. The success of national-level scale-up of a FBP program will also depend on

the availability of trained clinical staff and monitoring and evaluation of implementation.

6). Support pre-service curriculum development and training in nutrition and HIV in nursing and medical

schools. FANTA is conducting a comprehensive assessment of how nutrition and HIV are addressed in

current nursing and medical school curricula and identification of entry points for nutrition and HIV content.

In FY2010 (COP09), FANTA will continue their support USG/Vietnam, specifically to: (1) disseminate safe

infant and young child counseling and IEC materials in national pediatric hospitals, PMTCT programs, and

OPCs, as well as PLWHA support groups and HBC networks; (2) strengthen the national technical working

group on nutrition, food, and HIV and support for a focal person within NIN; (3) assist with implementation of

the RUTF program for clinically malnourished children, including systems for distribution to clinic sites,

inventory control, provision to patients, and record keeping based on the Kenya FBP program experience;

(4) work with VAAC, NIN, USG partners and to establish training and QA approaches to effectively integrate

and strengthen nutrition assessment and counseling for children within all PEPFAR-supported care and

treatment sites; (5) assist the same partners to establish guidelines and protocols for the introduction of the

FBP model for clinically malnourished PLWHA, PMTCT women and OVC in 20 hospitals and 25 health

centers; (6) provide recommendations on specifications for appropriate daily multi-micronutrient

supplements for adult PLWHA, PMTCT pregnant/lactating women and OVC whose diets are likely to be

inadequate to meet basic vitamin/mineral requirements; and (7) finalize national guidelines and protocols in

nutritional care and support of PLWHA.

Finally, FANTA will share current scientific knowledge and program experience from other countries with

PEPFAR/Ethiopia and its implementing partners, particularly with regard to linking clinical nutrition support

with food security and livelihood assistance, including "wrap-arounds" with food aid and MCH/nutrition

programming, to address the longer-term food and nutrition needs of PLWHA and their families.

New/Continuing Activity: New Activity

Continuing Activity:

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $120,000

and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10: