August 17, 2017 |

When nutrition comes first, HIV patients thrive

Fortified foods like Yummy Soy increase healthy outcomes for HIV patients, pregnant women, and kids.
A woman, nutritionist Mwatikosela Tembo, sits at a desk with James Siame, an HIV patient receiving NACS support, who reviews a flip chart about nutrition.
James Siame and Mwatikosela Tembo discuss the elements of a healthy diet, especially for a person taking HIV drugs. The Thrive project has reached more than 117,000 people in Zambia living with HIV, as well as orphans and vulnerable children, with lifesaving nutrition services. Photo: PATH/Gabe Bienczycki.

Mwatikosela Tembo beams as James Siame walks into her tiny office at Kitwe Central Hospital in Zambia’s Copperbelt region. This is his fifth visit to the nutritionist. On his first, five months earlier, James weighed just 72 lbs.

“He was really weak. He had to have people support him to stand,” Mwatikosela says.

James was plagued by nausea and dizziness and his legs had gone numb—side effects from antiretroviral medications (ARVs). The single father could no longer work and could barely feed his daughter or himself. His daughter had to drop out of school because he couldn’t afford the school fees.

James ended up in the hospital, and then in Mwatikosela’s office. There he learned that when it comes to HIV, nutrition is as important as drugs.

Food before drugs                                                              

As James experienced, taking ARVs on an empty stomach can exacerbate side effects. “If patients are not eating well, the side effects can become so severe that they could stop taking the drugs, and you can lose them,” says Beatrice Kawana, senior technical advisor for the PATH-led Thrive project. “Clients thrive at a faster rate if their nutrition needs are met and they are taking their drugs correctly.”

A woman, Theresa Chisha, a 40-year-old HIV patient whose condition has improved with NACS and use of HEPS, supported by the Thrive project, stands outside Mopani Chamboli Clinic (satellite clinic of the hospital).
With little food in the house, Theresa often took her HIV drugs on an empty stomach. Side effects from the drugs worsened and she became so weak that she couldn’t work. Without her income, her three children became malnourished, too. Photo: PATH/Gabe Bienczycki.

One-third of HIV-positive patients in Zambia are clinically malnourished, which increases their risk for opportunistic infections and death. But few HIV projects in the country incorporated nutrition until PATH and the Ministry of Health launched the Thrive project with funding from the United States Agency for International Development.

The Thrive project integrates nutrition assessment, counseling, and support (NACS) into routine care and treatment for people living with HIV, pregnant women, and orphans and vulnerable children. The project has trained more than 1,000 nutritionists, nurses, and pharmacists, from large public hospitals to private urban to small rural clinics to provide these services in four provinces. We’ve also developed local sources of high-energy protein supplements, dubbed HEPS, which are often prescribed to patients.

“You have to see nutrition holistically as part of treatment,” explains Beatrice. “Combining preventive and curative aspects helps clients regain the quality of life they’ve lost.”

A man, Bupe Macama, clinical officer and NACS focal person for Wusakile Mine Hospital and its satellite clinics, trained by PATH/Thrive project in incorporating nutrition into HIV clinical practice, stands outside Mopani Chamboli Clinic (satellite clinic of the hospital).
“Before there was no nutritional component to my clinical practice,” said Bupe Malama, a clinical officer at Wusakile Mine Hospital. “Now I understand the importance of nutrition better.” Photo: PATH/Gabe Bienczycki.

From maize meal to Yummy Soy

When Mwatikosela weighs James on his fifth visit, he is 128 lbs—almost within the range of normal BMI (or body mass index) for his height. After he thanks Mwatikosela for her help (“You’ve done a great job!”), a clinician examines James and shares good news—his viral load is down. Then he heads to the pharmacy to pick up his monthly supply of ARVs and Yummy Soy, the HEPS product manufactured by COMACO.

One of the most popular staples of Zambians’ diets is a porridge made of maize meal (corn flour) and water that is low in protein, vitamins, and minerals. Low-income people like James may eat it once or twice a day—and nothing else. HEPS, on the other hand, has added protein in the form of soy and critical vitamins and minerals.

James Musenda, a patient with HIV and TB, and Rebecca Anne Saiko, ART nurse trained in NACS by the Thrive project, standing outside Mopani Chamboli Clinic (satellite clinic of the hospital).
Yummy Soy and other HEPS products are protein- and vitamin-packed food supplements that look and taste a lot like corn porridge so they fit easily into people’s diets. Anyone, including HIV patients, can access HEPS in stores and community outlets. Photo: PATH/Gabe Bienczycki.

There are local HEPS producers in Zambia, but the quality was inconsistent and HEPS weren’t widely available. So we partnered with the Zambia Bureau of Standards to develop national standards and with two local manufacturers—COMACO and HIPRO—to ensure their products were safe, high quality, and affordable.

Then we created a commercialization strategy to help companies get their products on the retail market and build stable supply and demand. Yummy Soy and other HEPS products are now sold in stores and also distributed by local entrepreneurs in small shops, kiosks, and door-to-door, so that people in all income brackets can access them.

Making HEPS widely available could help address another of the country’s problems. An estimated 40 percent of Zambian children under age five are stunted due to chronic malnutrition and a corresponding lack of critical nutrients in their diets.

Musawa Kamanga, 13, stands with her grandmother outside the Children’s Inpatient Ward for Malnutrition, Kitwe Central Hospital, a location associated with the Thrive project.
Years of chronic malnutrition combined with side effects from HIV treatment almost cost 13-year-old Musawa her life. “Musawa was so sick, we had no hope that she’d make it,” her nurse said. HEPS for Musawa and nutrition education for her grandmother, who is raising her, brought Musawa back to a healthy weight. Photo: PATH/Gabe Bienczycki.

A great need

The need for nutrition services was even greater than initially realized. Our goal was to reach 70,000 people. To date, the project has served more than 117,000.

We designed the project to be sustainable, so the work will continue to thrive after the project closes. All 50 of the targeted health facilities have transitioned from receiving intensive support to providing NACS services on their own. The government is also assuming key functions like mentoring and supervision.

To ensure that the next generation of health workers is trained in NACS, we’re helping to revise the University of Zambia’s nutrition curriculum. And both HEPS producers have received Good Manufacturing Practices certification.

As Dr. Rick Henning, the project’s director, put it: “Our job is to be a catalyst for the idea, encourage, and then back off.”

Nutritionists like Mwatikosela are ready to take over the mantle. “I’m so happy patients are getting better,” she said. “We are doing something to change people’s lives.”

 

The Thrive project was made possible by the support of the American People through the United States Agency for International Development (USAID) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) with extensive cooperation from the Ministry of Health. 
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