MUMBAI PILOT PROJECT

This project proposes to increase the effectiveness of antiretroviral treatment (ART) in HIV-infected children in Mumbai, India by providing inexpensive nutritional support and counseling. Thousands of children in Mumbai are receiving daily ART and most of these children are also chronically malnourished. There is significant evidence that ART is most effective in well-nourished populations. The project will combine family nutritional and financial education with food supplementation utilizing a pre-established network of contacts with HIV-AIDS health care providers.

We are working with vulnerable patients identified by health care providers at Lokmanya Tilak Municipal General Hospital (Sion Hospital), in Mumbai. The project has two components: nutrition supplementation for the HIV infected child and family nutritional counseling. Our objectives for the summer are to hold initial nutrition counseling sessions with patients in the pilot program and to make sure the resources provided by AIDS Relief International are being used appropriately.

Malnutrition cannot be corrected overnight. Although we plan to hold intensive counseling sessions with families to help them identify affordable sources of food and rework their budgets to cover these expenditures, their children will not become healthy immediately. For this reason, we will deliver nutritional supplements to the HIV infected children in our program who are malnourished. Their parents will also receive the supplement if they are receiving ART and their doctors have expressed concerns with their diets, although few adults have this problem. The supplement we will provide is called Nutri-Mix, which is a dried, inexpensive powder, made from ingredients found in regions surrounding Mumbai. This supplement has been tested and specifically formulated for individuals receiving ART, its use of local ingredients is one reason why it costs only ten cents per day to provide a child with sufficient nutritional supplementation to make ART effective (CFBP Consumer Education and Testing Centre, Ref No. CFBP/208-2009/932/08).

The nutrition regimen itself will be evaluated after six months. Enough time needs to elapse in order to see an impact. The doctors at Sion Hospital have been treating these children for years and have extensive information about their medical history and current measurements such as weight and height. In order to gauge the children's progress on the regimen, we will receive monthly updates from Dr. Pallavi Laddha, the lead physician at Sion Hospital, and Dr. Bhami Shah, the chief child nutritionist at the center, who have already pledged their support for our project. Through these measures we can continue to improve the program.

Our pilot project in Mumbai proposes to increase the effectiveness of antiretroviral treatment (ART) in HIV infected children in Mumbai, India by providing inexpensive nutritional support. Thousands of children in Mumbai are receiving daily ART and most of these children are also chronically malnourished. There is significant evidence that ART is most effective in well-nourished populations. The project will combine family nutritional education with food supplementation.

The Indian government receives money from the Global Fund, Gates Foundation, and foreign governments to provide treatment for individuals living with HIV who have reached a low point in their CD4 count, an indirect measurement of their immune function. Right now approximately 50,000 adults and children qualify for ART from the government, but only 15,000 of those people are receiving treatment. There are factors that limit accessibility to the available treatment. Accessibility to clinics is one important issue in a sprawling city of 14 million persons, many without private transportation or money for public transport. A second, serious issue is the nutritional status of HIV-infected children.

In rural India there are programs that help AIDS patients grow their own food, similar to the approach taken by Gardens for Health. However, farming or gardening in the slums of urban Mumbai is not possible. These slums, originally multiple islands, are built on filled land that is not agriculturally sound. As the population expands, more land is reclaimed, including portions under the sea that were previously used as landfill.