SUMMARY: This activity will continue to improve counseling on infant and young child feeding and nutrition

practices (IYCF/NP) through monitoring. The activity will also prevent mother-to-child transmission (MTCT)

by improving nutrition practices of HIV-positive women. Increasing demand at the community level for

optimal nutrition practices in the context of HIV will assist with promoting HIV-free survival by preventing

malnutrition, MTCT, and mortality.

BACKGROUND: This work is a continuation of activities started in 2007 to develop an evidence-based

curriculum on IYCF/N for the Institut Haitien de Sante Communautaire (INHSAC) for health and community

workers. The goal for training health and community workers on IYCF/NP is to improve HIV-free survival in

infants and children (0-24 months) of HIV-positive women by decreasing the risks of MTCT, malnutrition

and child mortality. Feeding infants <6 months with a combination of breast milk, formula, and solids and

inadequate complementary feeding in children =6 months and older is reported to be common in Haiti.

These practices put all HIV-affected children at risk of mortality. In the infant <6 months of an HIV-positive

mother, these practices not only increase risk of mortality but also greatly increase MTCT. A goal continues

to be to increase HIV-survival of infants and young children by increasing the use of optimal IYCF/NP at the

household level.

ACTIVITIES AND EXPECTED RESULTS:

We will carry out five activities in this program area for Fiscal Year (FY) 2008.

ACTIVITY 1: This activity will improve counseling by health workers at facilities and in communities on

IYCF/NP in the context of HIV. In coordination with MSPP and its Department of Nutrition and INHSAC,

counseling will be improved by continuing to monitor counseling sessions and by conducting exit interviews

with women attending PMTCT clinics or community counseling sites. Information will be obtained during

periodic monitoring about IYCF/NP knowledge and practices in health and community workers during

counseling and HIV-positive women when feeding their infants including any barriers to these optimal

practices. To increase the coverage of other essential services for HIV-affected infants and children, this

activity also will investigate if health workers offer HIV-positive mothers the complete child survival package

for their infants and children including immunizations, essential drugs and nutrition interventions (e.g.,

nutritional assessment, vitamin A).

Monitoring information will be used to improve counseling on IYCF/NP in the context of HIV by revising or

augmenting the evidence-based curriculum, supportive supervision protocols and on-the-job training guides

for workers at PMTCT clinics (doctors, nurses, midwives, social workers) and in the community (community

health workers). Counseling tools, algorithms, job-aides, supervision tools, checklists, informational

brochures for women, etc. will be evaluated for their usefulness in counseling and the uptake of optimal

IYCF/N messages and practices.

ACTIVITY 2: This activity will incorporate information on maternal nutrition into the PMTCT curriculum to

improve the nutritional status of HIV-positive women. Because low birthweight (LBW) infants are at greater

risk of HIV-transmission and low CD4 counts are associated with measures of underweight in women, it is

imperative to ensure that maternal nutrition practices (MNP) and weight gain are adequate in pregnancy.

While it is true that LBW also is caused by HIV-infection in uteri and underweight in women may reflect the

progression of HIV, as measured by CD4 counts, it is prudent to ensure that MNP are optimal to counteract

any contribution malnutrition may be having in this process.

ACTIVITY 3: This activity will improve future program implementation efforts to increase demand for and

use of optimal IYCF/N and MNP in the context of HIV. To identify how to increase this demand and better

support optimal practices in communities, a community survey will be conducted, through interviews with

HIV-affected family members, about current IYCF/N and MNP. This survey also will identify facilitators and

barriers for using optimal IYCF/N and MNP including how family members, community leaders, community-

based organizations (CBO) and others are or can support optimal IYCF/N and MNP. This information will be

utilized in designing demand-side activities at the community level for increasing the use of optimal

practices (ACTIVITY 4) and will establish a baseline on current IYCF/N and MNP in the context of HIV

which will be used to evaluate program activities in the next phase.

ACTIVITY 4: This activity will increase the coverage of families' knowledge about optimal IYCF/N and MNP

in the context of HIV. Because other family member are often involved in feeding children or support

mothers to feed their children and themselves, information needs to be available at the community level to

influence other family and community members in support of using optimal IYCF/N and MNP in the context

of HIV. Some of this information will be provided to communities by community health workers trained by

INHSAC but to effectively improve coverage of the use of these practices in all HIV-positive women,

including those who do not attend PMTCT services regularly or who do not know their HIV status, and their

families, other channels of disseminating this information and supporting its use will be needed. Other

channels will be identified through the community survey (ACTIVITY 3) and may include USAID-funded

NGOs and programs, CBO and groups (e.g., mothers groups), schools, national campaigns such as Child

Health Weeks, and the media. Technical assistance will be provided as needed to strengthen the

dissemination of information through identified channels about optimal IYCF/N and MNP in the context of

HIV.

ACTIVITY 5: This activity will increase the knowledge of MSPP and its Department of Nutrition about new

findings from international research and current recommendations on optimal IYCF/N and MNP that will

ensure HIV-free survival of children. The project will provide information on studies, recommendations from

WHO, and best practice policies and strategies on optimal IYCF/N and MNP to ensure HIV-free survival of

children.

These results contribute to the PEPFAR Program Areas of 1 (PMTCT).

EMPHASIS AREAS:

- Community Mobilization/Participation: 20%

- Information, Education and Communication: 20%

- Linkages with Other Sectors and Initiatives: 10%

Policy and Guidelines: 10%

- Quality Assurance, Quality Improvement and Supportive Supervision: 20%

- Targeted Evaluation: 20%

TARGETS:

-- Number of health workers trained in the provision of PMTCT services according to national and

international standards : 250

TARGET POPULATIONS:

- Infants, children and youth (non-OVC)

- HIV-positive pregnant women

- HIV/AIDS-affected families

Activity Narrative: - Community leaders

- Host country government workers

- National AIDS control program staff

- Public health workers

- Doctors

- Nurses

- Traditional birth attendants

- Other health care workers

- Private health care workers

- Community-based organizations

- Faith-based organizations

- Non-government organizations/private voluntary organizations

- Implementing organizations (not listed above)

KEY LEGISLATIVE ISSUES:

Gender--1—developing/supporting policies to increase access to information, services, and care for women

and girls.

COVERAGE AREAS: National