1. MODULE ONE
HIV &TB PROGRAMME DESIGN
PRINCIPLES
1

2. Outline of the Module
I • Basic information on HIV/AIDS, TB, Malnutrition and Food security
II • Global Perspective: role and responsibilities within UNAIDS DoL
III • HIV response in Humanitarian settings
IV • WFP HIV and AIDS Policy and Programme Strategy
V • How to design an HIV and TB Programme
VI • Overview of funding opportunity within Global Fund
VII • Module Test
2

3. BASIC INFORMATION ON
HIV/AIDS, TB, MALNUTRITION AND
FOOD SECURITY
3

4. What is HIV/AIDS
• Stands for Human Immunodeficiency Virus
• It is a special type of virus called “retrovirus”
HIV • The virus kills white blood cells called CD4 lymphocytes that are responsible for the
immune response
• Acquired because is a condition one must acquire or get infected with
• Immune because it affects the immune system
AIDS • Deficiency because it makes the immune system deficient
• Syndrome because the person may experience a wide range of diseases and
opportunist infections
• A person HIV positive can stay from 2 to 10-15 years before having CD4 below the
HIV vs threshold and thus developing symptoms
AIDS • AIDS when a) CD4 count drop below 350 cell/mm3; b) The infected person shows
symptoms mainly due to opportunist infections, such as TB
• Only specific fluids (blood, semen, vaginal secretions, and breast milk) from an HIV-
TRANSMISSION infected person can transmit HIV
• These specific fluids must come in contact with a mucous membrane or damaged tissue
or be directly injected into the blood-stream for transmission to possibly occur
• No curative treatment and no vaccine
• Antiretroviral (ARV) drugs: When these drugs are given to patients, their viral load
TREATMENT decreases and their CD4 cell counts increase
• ARV drugs are never given one at a time, but always in combination, thus “therapy”
• ART stands for Antiretroviral Therapy. All patients with CD4 <350cells/mm3 should be
treated 4

5. What is TB & linkages with HIV
• Tuberculosis (TB) is caused by a bacterium called Mycobacterium Tuberculosis.
TB • The bacteria usually attack the lungs
• Not everyone infected with TB bacteria becomes sick. As a result, two TB-related
conditions exist: latent TB infection and TB disease
DISEASE • Latent infection: TB bacteria can live in the body without making you sick
• Disease: TB bacteria become active because the immune system can't stop them from
multiply
• TB is spread through the air from one person to another trough sneezes, speaks, or sings.
TRANSMISSION People nearby may breathe in these bacteria and become infected
TB and HIV • For people whose immune systems are weak, especially those with HIV infection, the risk
of developing TB disease is much higher than for people with normal immune systems
• TB disease can be treated by taking several drugs, usually for 6 to 9 months
• Directly Observed treatment Short Course (DOTS) is an internationally recommended
comprehensive approach to TB control, used since 1995. It is five-point package to; I)
TREATMENT Secure political commitment with adequate and sustained financing II) Ensure early case
detection, and diagnosis through quality-assured bacteriology III) Provide standardized
treatment with supervision, and patient support IV) Ensure effective drug supply and
management and, V) Monitor and evaluate performance and impact
5

6. GLOBAL SUMMARY
AIDS Epidemic
Number Total 34.2 million [31.8 million-35.9 million]
of PLHIV
Adults 30.7 million [28.6 million-32.2 million] Adults and children estimated to be living with HIV |2011
Women 16.7 million [15.7 million-17.8 million]
Children1 3.4 million [3.1 million-3.9 million]
People Total 2.5 million [2.2 million-2.8 million]
newly
infected
with HIV Adults 2.2 million [2.0 million-2.4 million]
in 2011
Children1 330000 [208 000-380 000]
AIDS Total 1.7 million [1.6 million-1.9 million]
deaths in
2011
Adults 1.5 million [1.3 million-1.7 million]
Children1 230 000 [2000 000-270 000]
UNAIDS epidemiology, 2012
1. Children < 15 years old 6

7. GLOBAL SUMMARY
ART Coverage
Eligibility for antiretroviral therapy versus coverage, low- middle-income countries, by region, 2011
7
UNAIDS, together we will end AIDS, 2012

8. What is Malnutrition
• A state in which the physical function of an individual is impaired to the point
where he or she can no longer maintain adequate bodily performance processes
such as growth, pregnancy, lactation, physical work, and resisting and recovering
MALNUTRITION from disease
• Malnutrition is a broad term commonly used as an alternative to undernutrition
but technically it also refers to overnutrition (overweight and obesity)
• It occurs as low body weight, short stature, micronutrient deficiencies, low birth-
weight and suboptimal breastfeeding practices
UNDERNUTRITION • For HIV and other infections (such as TB) undernutrition is the commonest form
of malnutrition observed. In particular: low body weight, weight
loss, micronutrients deficiencies that affect immune system
• They are used to assess low body weight
• In Children are mostly used Weight for Height (W/H) & Mid-Upper Arm
Circumference (MUAC)
ANTHROPOMETRIC
MEASUREMENT • For PLW it is used MUAC
• For Adult Man & Non-pregnant Women it used Body Mass Index (BMI) that it is
calculated by taking a person's weight and dividing by their height squared
Formula: weight (kg)/ [height (m)]2
8

9. HIV & Malnutrition
& WHY FOCUS ON NUTRITION Vicious cycle
2 3 To increase
To faster weight immune system
gain strength
1
To balance
nutrients loss
4 To improve
treatment
outcomes &
effectiveness
5
To improve treatment access and adherence
9

10. Tuberculosis & Malnutrition
& WHY FOCUS ON NUTRITION Vicious Cycle
• Reduced appetite, ability to take food and increase loss of weight
• Reduce ability of body to absorb nutrients To faster weight gain
• Reduced access to food due to morbidity/low productivity & balance nutrient
• Increased nutritional needs through metabolic changes loss
2
Tuberculosis (TB) Malnutrition
To improve treatment
effectiveness and To increase
faster treatment immune system
1 success strength
3
• Weakens the immune system, this increase likelihood of progression from
latent infection to active disease
• Increased risk of mortality for those with low BMI (on treatment)
• Impair adherence to treatment and may compromise access to treatment
4
To improve treatment access and adherence 10

11. Benefits of good nutrition for PLHIV and their families
Example of the crucial role of food and nutrition support in the success of the treatment
11

12. What is Food Insecurity
FOOD INSECURITY
• A situation in which household members lack stable, secure access to sufficient amounts of
safe and nutritious food for normal growth and development and an active and healthy life
• Food security comprises three elements: availability ,access and utilization
• Amount of food that is physically present in a country or area through all forms
AVAILABILITY of domestic production, commercial imports and food aid.
• Households' ability to regularly acquire adequate amounts of food through a
ACCESS combination of their own stock and home
production, purchases, barter, gifts, borrowing or food aid.
• It refers to: (a) households’ use of the food to which they have access, and (b)
UTILIZATION individuals' ability to absorb nutrients – the conversion efficiency of food by
the body
12

13. HIV, Tuberculosis & Food Insecurity
& WHY FOCUS ON IT Vicious Cycle
• Reduced utilization of food due to loss appetite, ability to take food
and reduced metabolism
Mitigate the affect
• Reduced access to food due to morbidity/low productivity of HIV & TB on
• Reduced productivity and out-put including non-food households
2
Food Insecurity
Availability
Tuberculosis (TB)
Increase food access
&
1 Accessibility
HIV/AIDS
Utilization
• Weakens the immune system, this increase likelihood of progression from latent
3 Reduce coping
infection to active disease mechanism
• Increased livelihood of engage in irreversible, negative coping mechanism
• Prevent people from seeking a diagnosis and/or initiating and adhering
treatment
4 13
Increase treatment adherence and outcomes

14. GLOBAL PERSPECTIVE
ROLE AND RESPONSIBILITIES WITHIN DoL
14

15. UNAIDS Cosponsor Joint Outcome Framework
Division of labour area Convener (s)
Reduce sexual transmission of HIV World Bank
cosponsors UNFPA
Prevent mothers from dying and babies from becoming infected WHO
HIV UNICEF
Ensure that PLHIV receive treatment WHO
Prevent PLHIV from dying of tuberculosis WHO
Protect drug users from becoming infected with HIV and ensure UNDOC
access to comprehensive HIV sensitive for people in prisons and
other closed settings
Empower men who have sex with man, sex workers and UNDP
transgender people to protect themselves from HIV infection and UNFPA
fully access antiretroviral therapy
Remove punitive laws, policies, practices, stigma, and UNDP
discrimination that block effective responses to AIDS
Meet the HIV needs of women and girls and stop sexual and UNDP
gender-based violence UNFPA
Empower young people to protect themselves from HIV UNICEF
UNFPA
Enhance social protection for people affected by HIV UNICEF
World Bank
Address HIV in Humanitarian emergencies UNHCR
WFP
Integrate food and nutrition within HIV response` WFP
Scale up HIV workplace policies and programmes and mobilize the ILO
private sector
Ensure high-quality education for a more effective HIV response UNESCO
Support strategic, prioritized and costed multisectoral national World Bank
AIDS plans 15

16. WFP 2011 HIV/TB Operations Overview
OPERATIONS # of Countries 38 BENEFICARIES Total beneficiaries: 2,259,200
OVERVIEW OVERVIEW
with HIV/TB project HIV2: 1,196,570
C&T beneficiaries: 1
# of HIV/TB project 51 TB : 209,965
1, 406,535
# of HIV/TB Emergency 4 HIV: 228,269
M&SN
project in
Recovery 27 beneficiaries:
context of: TB: 260,658
852,665
Development 20
OVC: 363,738
1 Under HIV are included both ART and PMTCT beneficiaries
2 Under C&T are included clients and their households
16

17. WFP 2011 HIV/TB Programmes by Region
ODC
Region Beneficiaries No. of 1%
Countries
ODD
ODJ/N
6%
South-East 1,504,561 16 ODP
Africa 12%
ODB
309,899 6
Asia ODB
ODP 14%
277,215 3 ODJ/N
LAC
67%
ODD
135,870 12
West Africa
ODC
Middle East
31,655 1 Beneficiaries by Region
17

18. WFP Global Contribution to HIV
Countries with Highest HIV prevalence rate
Countries with 25 Highest HIV Prevalence Rates
Rank Country HIV Prevalence Rank Country HIV Prevalence
1 Swaziland 25.9 14 Gabon 5.2
2 Botswana 24.8 15 Equatorial Guinea 5.0
3 Lesotho 23.6 16 CAR 4.7
4 South Africa 17.8 17 Nigeria 3.6 In 2011, WFP
worked in 64% (16)
5 Zimbabwe 14.3 18 Chad 3.4
of the 25 countries
6 Zambia 13.5 18 Rep. of Congo 3.4 with the highest
7 Namibia 13.1 18 Cote d’Ivoire 3.4 HIV prevalence
rates
8 Mozambique 11.5 21 Burundi 3.3
9 Malawi 11.0 22 Togo 3.2
10 Uganda 6.5 23 Bahamas 3.1
11 Kenya 6.3 24 Rwanda 2.9
12 Tanzania 5.6 25 Guinea-Bissau 2.5
13 Cameroon 5.3 25 Djibouti 2.5
Countries in blue, bold italic had WFP HIV activities in 2011
18

19. WFP’s Global Contribution to HIV
WFP Global Contribution to
UNAIDS Priority Countries
UNAIDS Priorities countries
31 UNAIDS Priority Countries
UNAIDS Priority Countries UNAIDS Priority Countries
Lesotho
Botswana
• In 2011, WFP supported HIV and
Brazil Malawi TB interventions in 16 out of the
Cambodia Mozambique 31 UNAIDS Priority Countries
Myanmar (52%)
Cameroon
Namibia
China
Nigeria
Congo DR
Russian Federation
• However, in 2011, WFP supported
Djibouti 38 countries with 51 HIV and TB
Rwanda
Ethiopia projects
South Africa
Guatemala
Swaziland
Haiti
Thailand • WFP provided assistance to
India Uganda approximately 5.8 % of the
Indonesia 6,650,0001 people receiving ART
Ukraine
Iran
Tanzania in low and middle income
Jamaica Zambia countries in 2011
Kenya Zimbabwe
Countries in blue, bold italic have HIV activities.
1 Global HIV/AIDS response-Progress report 2011 (WHO, UNAIDS, UNICEF) 19

20. WFP Global Contribution to TB
WFP’s Countries with Highest TB incidence rate
Global Contribution: TB
Countries with 26 Highest TB Incidence Rates 1
Ran Country TB Rank Country TB Incidence
k Incidence per 100,000
1 1,287 14 455
Swaziland Togo
2 981 15 436
South Africa Cambodia
3 682 16 384
Sierra Leone Myanmar
4 633 17 372
Zimbabwe Congo
In 2011, WFP worked
5 633 18 370
Lesotho Kiribati in 56% (14) of 26
19 Democratic 345 countries with the
6 620
Djibouti People's Republic
of Korea highest TB incidence
7 603
Namibia 20 337 rates
8 553
Mauritania
Gabon 21 334
Guinea
9 544
Mozambique 22 327
Congo DR
10 503
Botswana 23 CAR 319
11 502 24 304
Marshall Islands Angola
12 498 25 Papua New 303
Timor-Leste Guinea
13 462 26 298
Zambia Kenya
Countries in bold italic had WFP TB activities in 2011
1http://www.who.int/tb/publications/global_report/en/ and
20
http://www.who.int/tb/country/data/download/en/index.html

21. WFP’s Global Contribution: TB
WFP Global Contribution to TB
WHO Stop TB Plan II Priority Countries
(2)
WHO Stop TB Plan II Priority Countries
Country
1 Afghanistan
2 Bangladesh
3 Brazil
4 Cambodia
5 China
6 Congo DR
7 Ethiopia
8 India
In 2011, WFP supported TB programming in 8
9 Indonesia
10 Kenya out of the 22 WHO TB Priority Countries (36%)
11 Mozambique
12 Myanmar
13 Nigeria
14 Pakistan
15 Philippines
16 Russian Federation
17 South Africa
18 Thailand
19 Uganda
20 Tanzania
21 Viet Nam
22 Zimbabwe
21

22. HIV RESPONSE IN HUMANITARIAN SETTING
(PREPAREDNESS AND RESPONSE)
22

23. Partnerships
WFP’s Role in HIV in Emergencies
Within Joint Outcome Framework and
Division of Labour (2010):
WFP is co-convenor with UNHCR
to address HIV in Humanitarian
emergencies
23

24. IACS guidelines
HIV in Humanitarian Settings
Issued In 2004 by the Inter-Agency Standing Committee (IACS)
Assist humanitarian and AIDS organizations to plan the
delivery of a minimum set of HIV prevention,
Purpose treatment, care and support services to people affected
by humanitarian crises
Target Mid-level programme planners and implementers from
Audience agencies involved in providing humanitarian assistance
The tool is generic and can be applied to any
Use humanitarian setting in different epidemic scenarios
http://www.aidsandemergencies.org/cms/
1.HIV awareness;2.Health;3.Protection;4.Food
Multisectoral security, nutrition and livelihood;5. Education 6. Shelter;
response 7.Camp coordination and Camp management; 8.Water
sanitation and hygiene; 9. HIV in the workplace
24

25. IASC guidelines
HIV in Humanitarian Settings
Key sectors in humanitarian plan:
1 HIV awareness raising and community support
2 Health
3 Protection
4 Food Security, nutrition and livelihood support
5 Education
6 Shelter
7 Camp coordination and camp management
8 Water, sanitation and Hygiene
http://www.aidsandemergencies.org/cms/
9 HIV in workplace
For each of these sectors essential actions need to be taken in response to humanitarian crises
in two different phases: I) Early stages of any emergencies (minimum initial response) II)
expanded response
25

26. Example of action framework
Food security, nutrition and livelihood
Sector: Food security, nutrition and livelihood support
Preparedness Action Initial Response Expanded Response
sheet title
Preposition supplies in the country and at 1. Ensure food Target and distribute food assistance to Adapt agricultural methods and
regional hubs security, HIV-affected communities and households build capacity
nutrition and
Integrate HIV into existing food assistance Provide appropriate relief inputs
Determine criteria for food assistance to livelihood
and livelihood support programmes and and training to vulnerable and
affected individuals and communities support
food security, nutrition and livelihoods in affected households to
HIV projects and activities restore/rebuild livelihoods
Develop agreement on procurement of stocks,
transport and distribution of commodities Introduce specific measures to Adapt food distribution rations
protect/adapt the livelihoods of HIV- for hyperendemic settings
Train staff and partners on (a) integration of affected households and support
HIV interventions in food and nutrition homestead food production
programmes and (b) integration of food
security, nutrition and livelihoods skills in
support of PLHIV and OVC 2. Provide Ensure adequate nutrition and care for Expand nutrition and care
nutritional vulnerable PLHIV programmes for PLHIV
Integrate HIV proxy indicators (household support to Respond to the specific needs of Integrate nutritional support
headed by children or elderly, presence of a PLHIV pregnant and lactating women living with with other services
chronically ill person in a household) into food HIV and their children
Strengthen the capacity of PLHIV
security and vulnerability analyses and those on ART to provide for
their nutritional needs
26

27. Coordination of the HIV response
In Humanitarian Settings
UN Country Team, under UN Resident coordinator, activates in
Coordination coordination with the Government the cluster approach to
when cluster is coordinate the humanitarian response. UNAIDS Country
activated Coordinator is part of the Humanitarian Country Team and has
a role to ensure link between humanitarian response and
existing pre-crisis HIV coordination mechanisms and
programming capacity in the country
UNAIDS Country Coordinator should seek guidance from the UN
Coordination resident Coordinator/Humanitarian Coordinator on the
when cluster is humanitarian coordinator mechanism in place and should
not activated ensure appropriate linkages between the humanitarian
coordination mechanism and UN Joint Team on AIDS and the
National AIDS programme
27

28. Coordination of the HIV response
In Humanitarian Settings
HIV should be integrated into all the following actions
A B Resource mobilization: C
Needs assessment and Preparedness, contingency
information management: planning and early recovery: a) Inclusion of HIV into flash and
Emergency–specific needs all key humanitarian and HIV consolidates appeals like CERF; b)
should be integrated and actors should integrate HIV in reprogramming regular HIV funds
assessed into all sectoral initial all plans and activities from form bilateral donors and GF; c)
rapid assessments to determine preparedness and contingency Allocating existing funds for HIV
the scale and the type of planning to the humanitarian response;
assistance needed d)mainstream HIV programming
within other proposal for funding
WFP focal point should work with the Country Team to ensure HIV as well Food & Nutrition support are
captured within the needs assessments, contingency plan and resource mobilization
28

29. WFP HIV Strategy fitted in Humanitarian settings
Cote d’Ivoire: WFP
support malnourished Horn of Africa: WFP
ART clients in areas of Food and Nutrition strategy in support to
country most affected malnourished ART and
by displacement due HIV settings TB clients has been
to political turmoil integrated into the TSFP
HIV-SPECIFIC INTERVENTIONS
1 2
Care & Treatment Mitigation & Safety Nets
• Malnourished ART, TB-DOTS and • Food insecure HH affected by
PMTCT Clients HIV/TB (HH of ART, TB-DOTS pre-
• Sometimes HH members ART, PMTCT clients and OVC)
Ethiopia: Training to
3 decentralised government
officials to ensure
Food for Nutrition: familiarity to HIV and thus
General Food asset/Food for Targeted guarantee appropriate HIV
School feeding
Distribution work/Food for Supplementary response in areas hosting
trainings Feeding refugees
In DRC and South Sudan,
where it is uncertain HIV HIV-SENSITIVE INTERVENTIONS
impact, WFP offered
support to extremely 4
vulnerable population, Enabling environment:
ensuring sensitivity to
HIV/AIDS issue
advocacy/advisor role to government and collaboration with stakeholders
29

30. WFP HIV AND AIDS POLICY
&
PROGRAMME STRATEGY
30

31. OVERVIEW
CORPORATE CHANGES between 2010-2011
HIV and AIDS POLICY
1 2 2010 PROGRAMME CATEGORY REVIEW
In 2010, a new WFP In the 2010 programme
HIV and AIDS policy category review session
has been approved. of the Executive Board
2 attention was called to
Two main pillars have been the need for a clearer link
0 outlined between programme
category and Strategic Objectives (SO)
1
0 HIV/TB PROGRAMMING REVIEW
Previous the 2010 Programme category review all HIV and TB activities were classified under SO4. With the
closer link established between programme category and SO, HIV and TB activities have been added to SO1
and SO3, as well
3
STRATEGY RESULT FRAMEWORK REVIEW HIV &TB M&E FRAMEWORK REVIEW
2 In 2011, the 2008-2013 SRF has been revised to Based on the new SRF, a new HIV and TB M&E
0 translate its mandate and strategy into tangible
outcomes by linking the five SOs with specific
framework has been designed and corporate and
project specific outcomes introduced. HIV &TB
1 corporate outcomes and outputs, measured by M&E guidelines finalised and shared
indicators 31
1

32. WFP HIV and AIDS POLICY
HIV and AIDS POLICY
In 2010, a new WFP HIV and AIDS policy has been
approved
While continuing to affirm the importance of safety nets
in mitigating the effects of HIV, the new policy places
stronger emphasis on good nutrition as a critical part of
any HIV and TB regimen
The Policy outlines two main pillars:
1. Care and Treatment: Ensuring nutritional
recovery and treatment of individual
2. Mitigation and Safety Nets: Mitigating the
effects of AIDS on individuals and households
32

33. HIV &TB Programme Pillars
The Policy outlines two programme pillars
1 2 Mitigation &
Care & Treatment Safety nets
Ensuring nutritional Mitigating the effects of
recovery and treatment AIDS on individuals and
households
Intervention Target Duration
• Nutritional assessment, education and counselling • NAEC for all infected • NAEC throughout the
(NAEC), including infant feeding treatment (TB)/life (HIV)
Treatment,
Care and • Specialised food products for nutritional • For all malnourished on • Food nutritional recovery
Support rehabilitation treatment usually 6 months
(Curative)
• Finite income transfer in the form of food , voucher • Households of • For duration of client support
or cash (conditional to the above) malnourished client (Curative)
• Finite income transfer in the form of food , voucher • Affected household • Until indicators of food
Mitigation or cash security improved
& Safety
Net • Finite income transfer in the form of food, voucher • Affected household • Based on need, may be
(Enabling/ or cash for household hosting orphans and hosting orphans and longer term
Preventative) vulnerable children vulnerable children
• HIV/TB-sensitive safety nets • All • Long-term 33

34. Pillar one: Care & treatment
Intervention Target Duration
• Nutritional assessment, education and counselling • NAEC for all infected • NAEC throughout the
(NAEC), including infant feeding treatment (TB)/life (HIV)
Treatment,
A
Care and • Specialised food products for nutritional • For all malnourished on • Food nutritional recovery
Support rehabilitation treatment usually 6 months
(Curative)
• Finite income transfer in the form of food, voucher • Households of • For duration of client support
or cash (conditional to the above) malnourished client (Curative)
A
NAEC is provided to all clients regardless the nutrition status. It is composed of:
• Nutritional assessment- the client’s nutritional status (anthropometric measurements)
and dietary practices are investigated and reviewed
• Nutritional Education- It include peer education, provision of information, education
and communication (IEC) materials
• Nutritional Counselling-Advices/suggestions are provided to any single client based on
the medical status on simple lifestyle changes on diet, exercises, health living in order to
manage metabolic changes and treatment side effects
34

35. Pillar one: Care & treatment
Intervention Target Duration
• Nutritional assessment, education and counselling • NAEC for all infected • NAEC throughout the
(NAEC), including infant feeding treatment (TB)/life (HIV)
Treatment,
Care and • Specialised food products for nutritional • For all malnourished on • Food nutritional recovery
Support rehabilitation treatment usually 6 months
(Curative) B
• Sometimes, finite income transfer in the form of • Household of • For duration of client support
food, voucher or cash (conditional to the above) C malnourished client (Curative)
B
• Specialised Food products is only for those clients found to be malnourished during the nutritional
assessment
• They receive a nutritional supplement, usually composed of fortified blended food ration
integrated with salt and sugar
• It is a short term intervention aimed to rehabilitated from malnutrition, thus it is provided
until the client reaches specific anthropometric target with a maximum of 6-8 months
C
• Income transfer (food, vouchers or cash) sometime, it is provided to the client’s households:
• It is conditional to the client’s support and will last until the client is discharged
• Income transfer should be designed either as a incentive or to complete the household’s
members diet
35

36. Pillar one: Care & treatment
Clinical process
36

37. HIV &TB Programme Pillars
The Policy outlines two programme pillars
1 2 Mitigation &
Care & Treatment Safety nets
Ensuring nutritional Mitigating the effects of
recovery and treatment AIDS on individuals and
households
Intervention Target Duration
• Nutritional assessment, education and counselling • NAEC for all infected • NAEC throughout the
(NAEC), including infant feeding treatment (TB)/life (HIV)
Treatment,
Care and • Specialised food products for nutritional • For all malnourished on • Food nutritional recovery
Support rehabilitation treatment usually 6 months
(Curative)
• Finite income transfer in the form of food , voucher • Households of • For duration of client support
or cash (conditional to the above) malnourished client (Curative)
• Finite income transfer in the form of food, voucher • Affected household • Until indicators of food
Mitigation or cash security improved
& Safety
Net • Finite income transfer in the form of food, voucher • Affected household • Based on need, may be
(Enabling/ or cash for household hosting orphans and hosting orphans and longer term
Preventative) vulnerable children vulnerable children
• HIV/TB-sensitive safety nets • All • Long-term 37

38. Pillar two: Mitigation & Safety Nets
Intervention Target Duration
C • Finite income transfer in the form of food , voucher • Affected household • Until indicators of food
or cash security improved
Mitigation &
Safety Net
• Finite income transfer in the form of food, voucher • Affected household • Based on need, may be
(Enabling/
or cash for household hosting orphans and hosting orphans and longer term
Preventative)
vulnerable children vulnerable children
• HIV/TB-sensitive safety nets • All • Long-term
D
C• This intervention support households affected by HIV or TB that also exhibit other
vulnerabilities such as food insecurity and asset depletion, including households hosting OVC
• It is a temporary relief intervention during the acute stage of disease for clients
receiving care and treatment
• It is should be designed according to food security needs, including food availability,
access and utilization
• Households are targeted based on food insecurity information
D All the interventions should be linked to livelihood promotion activities such as Food for
•
Assets (FFA), Food for training, Food for Work, Income generating Activities (IGA) to ensure
economic/productive recovery and long term adherence
38

39. 2010 Programme Category Review
& Strategic Objectives
Programme Category Strategic Objective
EMOP SO1
PRRO SO3, sometime SO1
CP and DEV SO4
Cross-Cutting SO2 and SO5
Strategic Objective 1: Save lives and protect livelihoods in emergencies
Strategic Objective 2: Prevent acute hunger and invest in disaster preparedness and mitigation measures
Strategic Objective 3: Restore and rebuild lives and livelihoods in post-conflict, post-disaster, or transition situations
Strategic Objective 4: Reduce chronic hunger and undernutrition
Strategic Objective 5: Strengthen the capacities of countries to reduce hunger, including through hand-over
strategies and local purchase
39

40. The 2010 Programme Category
& the HIV/TB programming REVIEW
Before
After 2010
2010
Following the programme categories review, ODXP successfully
advocated to include HIV and TB activities also to SO1 and SO3
Previous to the PROGRAMME STRATEGIC HIV&TB
programme CATEGORY OBJECTIVES PROGRAMME
category
EMOP SO1 Care & Treatment
review
session: all HIV
and TB SO3, sometime Care & Treatment
PRRO
activities were SO4
Mitigation &Safety Net
classified
under SO4 CP/DEV Care & Treatment
SO4
Mitigation & Safety net
40

41. Workflow of outcomes
From shock to development
In an emergency context In a recovery/transition context In a development context
(EMOP): (PRRO), HIV/TB activities should (CP/DEV) allows for a longer-
be focused on: term focus, HIV/TB activities
Food assistance has a role can concentrate on:
in stabilizing and • Nutritional recovery of
maintaining access to clinically malnourished ART • Nutritional recovery of
treatments by preventing and TB clients for improved malnourished ART and TB
default treatment adherence and a clients
return to a productive life
• Improve adherence to ART
• To prevent the adoption of or TB treatment success
negative coping strategies
and the deterioration of • Support food insecure
productive assets of households affected by HIV
households affected by HIV or TB, including OVC
or TB, including OVC
41

42. ‹#›

43. ‹#›

44. HOW TO DESIGN
HIV & TB PROGRAMMES
44

45. Step I
Context analysis
Fist of all, it is crucial to define the CONTEXT CATEGORY, thus if we are in
• Emergency
• Transition phase
• Development context
1. Know your epidemic
• Describe HIV & TB epidemiology (HIV and TB prevalence, incidence; HIV/TB co- infection, etc.)
• Distinguee between concentrated and generalised HIV epidemic
• Describe the HIV underlying determinants
2. Know your national ART and TB treatment coverage and outcomes
• Describe the ART and TB coverage
• Provide information on adherence, default rate, TB treatment success, etc.
• Describe the factors that hinder or facilitate ART and TB treatment access and success
3. Know the food security and malnutrition levels in your context
• Provide information on food insecurity, poverty levels, malnutrition rates, etc.
• Provide geographically distribution of food security
4. Describe the linkages
• Linkages between malnutrition and HIV and AIDS
• Linkage between HIV and AIDS and food insecurity 45

46. Step 2
National Framework- Policy and Capacity
1. Describe National Policy Context
• Indicate the presence of HIV National Policy Context
• Indicate the presence of Nutrition Policy including HIV information
• Indicate the presence of Nutrition Guidelines and if integrated with HIV
2. Describe the extent of implementation of national strategy and level of funding outcomes
• Provide information on the programmes implemented national wide by the Government and other
partners
• Provide information on the financial situation
3. Describe the presence of co-ordination mechanism & key stakeholders
• Indicate the presence of any national and/or UN HIV and TB co-ordination body
• Define key stakeholders and their roles within the HIV&TB framework
4. Outline WFP participation within the HIV and TB framework
• WFP roles within the national framework
• WFP participation within the UN Joint Country Team on HIV
46

47. Step 3 Identification of strategy and target
Care & treatment Mitigation & Safety net
Also Know Rehabilitation of moderate malnourished ART Household (HH) support for ART/TB/PMTCT/OVC
and/or TB clients
Purpose Improve health and/or treatment outcomes in Support affected by HIV/TB that exhibit vulnerabilities
clients who are malnourished (food insecurity, asset depletion, etc.)
Clients served Individual targeting based on nutritional status HH targeting based on food insecurity data
Targeting ART, TB, PMTCT, pre-ART clients and sometimes HH of ART, TB, PMTCT, Pre-ART clients and OVC
their households (HH)
Entry Criteria Undernutrition/Anthropometric screening Food insecurity
Exit Criteria & Until client reaches specific anthropometric target Until food security indicators improves or limited
duration with a maximum duration of 6 months or 8 timeframe of 6 months or 12 months
months for TB clients
Client ration Energy-dense food commodities (FBFs or RUFs) N/A
Household HH support is conditional to client’ s support and HH support contributes to HH food access, income
support will last up to client’s discharge. This support seen transfer, asset protection, reduction in adoption of risky
as income transfer and an enabler for treatment behaviours, and is an enabler to improve participation
in services (school, training, PMTCT, etc.)
Family ration If provided it should be designed either as an It should be designed according to food security needs
incentive or to complement the HH’s members including food availability and access, food utilization,
diet to meet daily requirements dietary diversity, nutritional balance, etc.
Complementary Nutritional education & counselling- throughout Linkages with livelihood activities, such as FFA, FFT, IGA
activities the program for clients in order to ensure economical/productive recovery and
Equipment, time and capacity building long term adherence 47

48. EXAMPLE: “AMBROSIA” Country
Understand Country Context
Understand country context
Ambrosia: Development context
1 2
Context analysis National Framework
HIV EPIDEMIOLOGY NATIONAL STRATEGIES
• 1.8% HIV prevalence (14-49 year) • Nutrition identified as critical element for
• Higher prevalence in Northern (3%) and HIV treatment in the National Strategic
Eastern regions (4%) Plan (NSP) on HIV and AIDS
• 35% ART Coverage • Ghana Health Service National developed
• 40% default rate a nutrition protocol for PLHIV
• 23% HIV/TB co-infection • Government provides free access to ART
POVERTY & FOOD INSECURITY PARTNERSHIP
• 135 out of 187 countries in the UNDP • UNICEF/WFP assisting MAM PLW and
Human Development Index Children under MCHN (activity sensitive to
• About 16.3% of HIV-affected households HIV)
are food insecure and 32% classified as
Vulnerable to food insecurity
3 Identifying needs and gaps
48
This case study is not based on a real situation, the information is hypothetical and has been added to better illustrate explain how to design a programme

49. EXAMPLE: “AMBROSIA” Country
GAP ANALYSIS & IDENTIFICATION OF STRATEGY
Understand country context
1 2
Understand
Context analysis
national response
3 Identification of needs and gaps
GEOGRAPHICAL DISTRIBUTION
High HIV in Northern and Eastern regions CURRENT INTEVENTIONS & PARTNERSHIP
(4%)
Lack of interventions aimed to support adults
HIV/TB & FOOD INSECURITY on ART and/or TB treatment
• High default rate
• HIV-affected HHs are food insecure
Describe your strategy
GEOGRAPHICAL COVERAGE PROPOSED INTERVENTIONS
Northern and Eastern regions • DEV project
• C&T for malnourished ART and TB clients
TARGET (no PMTCT because covered under MCHN)
• Malnourished ART and DOTS clients and their HH (HH size of 5 members)
• Food insecure HH • M&SN for HH affected by HIV based on
food insecurity level
49

50. Step 4
Definition of beneficiaries
Definition of Beneficiaries
An individual who is entitled to WFP food at distribution site, either on-
Index Client
site consumption or as a take-home ration
A social unit composed of individuals, with family or other social
relations among themselves, eating from the same pot and sharing a
Household
common resource base
Household of ART, TB, pre-ART and PMTCT clients entitled to food
Household of assistance either under C&T (conditional to client’s support) or M&SN
clients (to compensate for lost income and as enabler to improve
participation). The household size average is estimated of 5 members
Household of Household hosting Orphans and Vulnerable Children likely due to
OVC HIV/AIDS and/or TB. The household size average is estimated of 5
members
50

51. Step 4
Estimation of client caseload
Use the information collected to estimate the new caseload, bearing in mind
If the programme potential variations which might affect the programme such as geographically
already in place re-orientation, food insecurity, roll out strategies, etc.
If targeting is:
Malnourished PLW with HIV or TB
• Estimated population of pregnant and lactating women of children under 6 months
of age * Estimated HIV or TB prevalence in this group (if not available use HIV
If it is new or a prevalence in child-bearing age women) * Estimated of PLW on ART or DOTS
treatment * Malnutrition prevalence for this group (if not available use a proxy from
reviewed other country or international publication)
programme
Malnourished Man or Malnourished Women or Malnourished Children with
HIV or TB
• Estimated population of women or man or children * Estimated HIV or TB prevalence
in this group * Estimated on ART or DOTS treatment * Estimated malnutrition
prevalence for this group (if not available use a proxy from other country or
international publication)
Caseload = Population * HIV or TB Prevalence * Treatment coverage * Malnutrition prevalence
51

52. Step 4
Estimation of household caseload
HH support is conditional to the malnourished client, thus :
Household • the number of HH correspond to the number of malnourished clients
support in C&T • the number of household’s members is calculated normally multiplying the number of
clients by an average of five members per HH
HH support is based on food insecurity data
Estimated number of beneficiaries of HH affected by HIV/TB, hosting ART, DOTS and PMTCT
clients
• [Estimated population in target geographical zone* Estimated HIV or TB prevalence in
this group * Estimated on ART or DOTS treatment * Food insecurity rate in this group (if
not available food insecurity in general population)]* Average of HH size (usually 5
members)
Household
HIV/TB HH members caseload = (Population * HIV or TB prevalence * Treatment
support in
coverage * Food insecurity) * Size of HH
M&SN-
Estimated number of beneficiaries of HH affected by HIV/TB, hosting OVC
• Estimated population in target geographical zone* Estimated OVC prevalence * Food
insecurity rate in this group (if not available in general population)* Average of HH size
OVC HH members caseload = (Population * OVC prevalence * Food insecurity) * Size
of HH 52

53. Step 5
Ration design
• SUPERCEREAL, oil & • SUPERCEREAL, oil & sugar • FOOD BASKET
sugar (INDIVIDUAL) (INDIVIDUAL) • or CASH&VOUCHER
• Adult ART, TB and PMTCT • + FOOD BASKET or • (HH members, including
malnourished clients CASH&VOUCHER clients)
(CLIENT HH MEMBERS)
Care & treatment – INDIVIDUAL +HH SUPPORT
Care and Treatment- INDIVIDUAL ONLY (client)
• SUPERCERAL PLUS • Individual ration for client only
Mitigation & Safety nets HH SUPPORT ONLY
• All ration calculated for 5 HH
(Children 6-59 months) • This HH basket is conditional to members, including client
the client’s support- calculated • Designed based on Food
for average of 5 HH members
security data
(client included)
• Designed based on food security
data
Ration Nutrients Ration Nutrients Ration Nutrients
-
profile (Example) profile (Example) profile
Supercereal 1 1000-1200 (INDIVIDUAL) 1000-1200 Kcal Maize 160 g 836 Kcal
Supercereal 1
200-250 g Kcal 35-45 g protein Supercereal 20g 22 g protein
Oil 20-25 g 35-45 g 200-250 g 30-40 g fat Pulses 24 g 14 g fat
Sugar 15-20 g protein Oil 20-25 g Oil 10g
30-40 g fat Sugar 15-20 g +
+ Rice 320 g 1658 Kcal
1
(HH SUPPORT) 1100 Kcal Pulses 50g 44 g protein
The ration of Supercereal should be
preferably integrated with sugar and oil.
Maize 200 g 31 g protein Oil 20g 24 g fat
However each CO can decide based on Pulses 60 g 9 g fat Supercereal 40g
national situation. Oil 20g 53

54. Step 6
Design your logframe
Programme Corporate
Corporate Project
Category Strategic & Project
Specific
(EMOP, PRRO, Objectives Outcomes Specific
DEV/CP) Outcomes
Indicators
Project activities and outcomes should be linked to the relevant WFP Strategic
Objectives (SO) and follow the correct programme category per each SO
Corporate outcome(s) and indicator(s) corresponding to the SO should be inserted
in the logframe. Targets should be set according to the country’s context
Additional and optional project specific outcomes and related indicators can be
chosen to build up a body of data that provides a more accurate and in depth
performance measurement providing a comprehensive picture of the project
dynamics
54

55. Step 6
Design your logframe
55

56. Resource-constrained Settings
How design a Programme
In resource constrained settings these steps need further consideration in order to prioritise activities, fine-tune
the interventions and thus elaborate a cost efficient technically-sound programme
Keys aspects to be addressed
• Vulnerability- Identify the most vulnerable subgroup amongst the vulnerable HIV/TB infected
TARGET and/or affected population
• Geographical coverage- Identify the most vulnerable area for high HIV prevalence, high Food
insecurity rate or a combination of both
Identified all the activities run in country by partners in order to
PARTNESHIP • Avoid overlapping
• Define possible linkages with programmes
• Synchronize/harmonise the interventions
• Encourage when possible short term interventions with clear exit strategy to avoid dependency
• Build and ensure linkages to productive safety nets livelihood interventions in order to
SUSTANAIBILTY
contribute to economic development of local community
• Assess the capacity of national entities that might be involved in the implementation in order to
ensure feasibility of a correct and effective execution
• Explore alternative source of funding and familiarize with different funding mechanism process
FUNDING of the main donors in case, in future, WFP is not longer able to support the interventions
• Assess the capacity of Government to sustain financially the programme in the future
• Assist the Government in resource mobilization process, such as GFATM 56

57. THE GLOBAL FUND
A FUNDING OPPORTUNITY
FOR FOOD AND NUTRITION INTERVENTIONS
57

58. WFP is the lead agency and responsible for integration of food
and nutrition into HIV response
HIV and/or TB increase nutritional needs of infected individual while decreasing ability of
taking food, absorbing essential nutrients and meeting energy needs required for a strong
immune system
Increased morbidity and HIV and TB treatment-related costs often impact negatively
household productivity, disposable income and food security
Food insecurity and poverty may create barriers to treatment adherence and retention in
care, while malnutrition increases risk of morbidity and mortality among people living with
HIV (PLHIV) or infected by TB
Food and nutrition (F&N) interventions as critical element of comprehensive HIV response
• Nutrition stabilization, improved access and adherence to treatment, reduced morbidity
and mortality, effective safety nets
As UNAIDS Cosponsor, WFP is lead agency and responsible for integrating F&N support into
HIV response 58

59. Food and nutrition (F&N) increasingly considered important
element of HIV and TB programming
Several organizations advocate F&N interventions increasingly included
for F&N in HIV/TB programmes in Global Fund proposals
100%
% of funded HIV proposals with F&N
90% component
80%
70% 60%
60% 55%
Global Fund PEPFAR WFP
50% 44%
40%
30% 23%
20%
10%
0%
UNAIDS WHO FANTA-2 Round 5 Round 6 Round 7 Round 8
Sources: Global Fund, http://www.theglobalfund.org/documents/rounds/11/R11_FoodNutrition_InfoNote_en/; PEPFAR,
http://www.pepfar.gov/press/strategy_briefs/138410.htm; WFP, http://home.wfp.org/stellent/groups/public/documents/resources/wfp221697.pdf; UNAIDS,
http://data.unaids.org/pub/Manual/2008/jc1515_policy_brief_nutrition_en.pdf; WHO, http://www.who.int/nutrition/topics/hivaids/en/index.html; FANTA-2, 59
http://www.fantaproject.org/downloads/pdfs/Food_Assistance_Context_of_HIV_Oct_2007.pdf; WHO: Analysis of Global Fund Round 5-10. Unpublished

60. PEPFAR and GF two main funders of global HIV response
International assistance to HIV at US$ 8.7 billion in 2009 and US$ 7.6 billion in 2010
Global source of funds for HIV and AIDS Programmes (US$ billion)
US$ billion
8
7
6 UNAIDS
5 Clinton Foundation
4 Global Fund (GF) -
HIV only)
3
PEPFAR
2
1
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
60
Sources: UNAIDS

61. US$ 9 billion potentially available from Global Fund for prevention
and treatment of 3 diseases over next 2 years
The Global Fund (GF) attracts and allocates resources to prevent and treat
HIV/AIDS, TB, Malaria and support Health System Strengthening
• Since 2002 US$ 22.9 billion committed in 151 countries for the three diseases
− 55% portfolio for HIV/AIDS programs, 28% malaria and 17% TB
The Global Fund
• Round 10 (2010) approved grants for US$ 1.7 billion
− 40% approved proposals focused on HIV/AIDS programs
GF does not implement programmes directly but fund programmes with
emphasis in scaling up proven concepts and filling gaps
• Programmes¹ should be technically sound, country-specific, evidence-based
and aligned with national strategy and capacity
Estimated US$ 9 billion potentially available over next years (3 diseases and
health system strenghtening)
• US$ 8 billion for Phase 2 existing grant re-programming
• US$ 1 billion for new funding mechanism - to be launched in Q4 2012
61
(1) Typical grant duration of 5 years – Phase 1 lasts 2 years and Phase 2 lasts 3 years

62. F&N interventions can be included in new GF proposal or during grant
re-programming (Phase 2 – Years 3,4,5)
Global Fund provides two types of funding opportunities for F&N interventions
1. Call for proposals
− Proposal written at country level in a multi-stakeholder process
− New funding mechanism under finalization
• National strategic plans and/or investments cases as starting point for any request
• Countries grouped in bands - funds allocated by band
2. Re-programming of existing grants (Phase 2 – Years 3,4,5)
− Grant re-programming can begin 18-24 months after starting implementation
When included, F&N component tipically accounts for 5-10% of a new proposal
budget
− US$ 1-10 million for a 5 years period can potentially be allocated to fund F&N
interventions
62

63. Overview of grant opportunities for ODD countries
Status of Global Fund Grants in ODD countries
GF grant in Ph. 1 (disease)
Opportunity for Reprogramming
and for new proposal submission
5 8
9M 17M 7 GF grant in Ph. 2 (round)
10 14M
TB 0.7
8 HIV 41M Opportunity for new proposal
7 HSS 12M 1.0
ss
0.8 submission only
ss HIV TB TB
TB
8M 12M xx US$ million potentially
5/10
8 8M
34M M available in total for grant
Reprogramming
63
Source of information: The Global Fund

64. Country-led multi-stakeholder platform leads GF process
4 stages of proposal development and grant implementation
New funding Reprogramming
Board approval
mechanism opportunity
1 2 3 4
Technical review (TRP) –
Concept note development dialogue based on concept Grant negotiation Grant
note implementation
National strategy as starting point Technical review panel Final country-level PR and CCM
• Independent group of funding amount request for grant
GF Secretariat provides guidance on
international experts determined renewal after
level of funding
reviews concept note 18-24 months of
CCM (country coordination implementation
• TRP determine/approve Concept note
mechanism) enters dialogues with in- • Detailed
adjusted allocation translated into
country stakeholders information on
disbursement-ready
• Constituted by a multi-stakeholders grant grant renewal
partnership process:
http://www.theglobalfund.org/en/ccm/
http://www.the
Board approves globalfund.org/
CCM Secretariat coordinates concept disbursement-ready
note development en/activities/re
grant newals/
Technical writing group develop
concept note for CCM’s review
64

65. To tap future funding opportunities with Global Fund, critical to
invest time and engage in preparation phase…
1 PHASE 1 – CONCEPT NOTE DEVELOPMENT
Lay the ground: prepare tools Active participation in TWG
for engagement and national workshops
Goal Open doors for F&N Include F&N into GF proposal
• Active participation in
workshops analysing national
A Situational response, gaps and needs to
assessment shape proposal priorities
What does
it mean in B Intervention • Integration and active
practice? design participation in technical
writing group (TWG) for Global
C Stakeholder Fund proposal development
collaboration
65

66. …and to make sure F&N does not drop out last minute
During grant implementation, critical to be alert for reprogramming opportunities
Reprogramming opportunity
3 4
Grant implementation
Grant negotiation
Goal Avoid F&N drop out last Be alert on reprogramming
minute potential
• Maintain close relationship • Maintain relationship with
with CCM, TWG and Nutrition CCM structures and
coalition members Principal Recipient(s) and
Sub-Recipients(s)
What does
it mean in • Ensure F&N stays in
practice? negotiated proposal • Be informed on
implementation progress
and Re-programming
opportunities
66

67. What tools are already available to WFP RBs, COs and Governments
to integrate F&N into successful proposals?
Available toolkits to develop F&N interventions for HIV response (short selection)
WFP manual for stakeholders in the provision of F&N interventions
Joint Global Fund info note on F&N for HIV response
http://www.theglobalfund.org/en/application/infonotes/
FANTA-2 and WFP toolkit for integrating F&N in GF grants
(http://www.fantaproject.org/downloads/pdfs/Round11_GlobalFundToolkit_O
ct2011.pdf)
WFP M&E Guide for HIV and TB Programming (2011)
http://docustore.wfp.org/stellent/groups/public/documents/manual_guide_pr
oced/wfp235338.pdf
WFP’s response to HIV and TB website and knowledge centre
(http://www.wfp.org/hiv-aids)
67

68. Customized technical assistance also available to COs and
Governments to tap potential funding opportunities
Available expertise from RBs, HQ
Recent success from TA to include F&N into GF proposals and Geneva
Haiti (HIV) 1.2M
Technical assistance to COs and
Afghanistan (TB) Governments
Cape Verde • Advocate for F&N
Senegal
Mauritania
Mali Niger Sudan • Presentation on funding
Chad Djibouti (TB) mechanisms for F&N
Gambia Burkina Faso
Guinea-Bissau Guinea
Nigeria
• Support GF proposal
Sierra Leone Ghana South Ethiopia
Central
African Rep. Sudan development with sound F&N
Liberia (HIV) Togo Benin
Somalia
Cameroon
Uganda Kenya
component
2.7M Côte d'Ivoire 6M Congo The
Democratic Rwanda
0.5M Republic Burundi Situation analysis and coalition
of the Congo
United
Republic of
building at country level
Tanzania
Malawi
• Available tools and expertise
Zambia
Mozambique
F&N included into GF proposal – Zimbabwe On-going effort at global level
proposal approved Madagascar
to advocate for F&N and liaise
F&N included into GF proposal – 9.7M with stakeholders
proposal under review by GF
South Swaziland
Budget for F&N component included Africa (OVC and TB)
XM
into GF proposal Lesotho
68