TABLE 6-9 Number of HIV-Positive Clinically Malnourished Clients Who Received Therapeutic or Supplementary Food (in Thousands)

FY 2010 Result FY 2010 Target
Total 256.7 457.3

NOTES: This table represents data for the 31 countries identified as the focus of this evaluation (see Chapter 2). Data correspond to indicator C2.3.D: number of HIV-positive clinically malnourished clients who received therapeutic or supplementary food. This includes only clients who meet diagnostic criteria based on anthropometric assessment. Food provided for household use or as a safety net is not included this indicator (OGAC, 2009d).
SOURCE: Program monitoring indicators provided by OGAC.

those under 5 years old, regardless of HIV status. These programs provide food and nutrition care and support, including nutrition assessment and counseling services, prescribed specialized food products, including those for treatment of malnutrition, and micronutrient supplementation (OGAC, 2009b). PEPFAR does not support direct food distribution to families, but emphasizes linkages and referrals of those in need to the USG Global Hunger and Food Security Initiative, USAID’s Title II programs, and other initiatives, such as the United Nations World Food Program (OGAC, 2009a,b,g). Linkages of this kind were described in several interviews in partner countries (240-15-USG; 636-9-USACA; 116-24-USNGO; 331-14-USG; 331-19-USNGO; 331-23-USNGO; 240-3-USG). Interviewees also described technical assistance for guidelines and training on nutrition and food support as well as the provision of nutrition services through various organizations and partners, including nutritional counseling at community health care centers and food support (934-7-PCGOV; 272-18-PCNGO; 240-25-PCGOV; 272-32/35-PCNGO; 587-6-CCM; 331-23-USNGO; 331-16-USG; 396-21-PCGOV).

With the NGI indicator revision, PEPFAR has a centrally reported indicator for the number of clinically malnourished HIV-positive persons receiving therapeutic or supplementary food (see Table 6-9). For FY 2010, PEPFAR fell short of its target for this service.

Palliative Care, Including Management of Pain and Other Symptoms

PEPFAR defines palliative care as a “holistic approach to providing services that includes a focus on pain and symptom management and on improving quality of life,” which is consistent with the WHO definition (OGAC, 2009b, p. 25; WHO, 2013). Palliative care, including end-of-life care, can also reduce the burden of caregiving on families (OGAC, 2009f). In many countries, restrictive policy environments are a barrier to effective pain management programs, and access is limited to strong pain medications such as opioids (OGAC, 2009f). PEPFAR’s second Five-Year Strategy calls for continued efforts to “support policy changes that ensure pain management is included both in guidelines and actual clinical services” for



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