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Aberman N.-L.,International Food Policy Research Institute | Rawat R.,International Food Policy Research Institute | Drimie S.,Stellenbosch University | Claros J.M.,Nutrition and HIV AIDS Policy | And 2 more authors.
AIDS and Behavior

The number of people receiving antiretroviral therapy in developing countries has increased dramatically. The last decade has brought an increased understanding of the interconnectedness between HIV/AIDS, food insecurity, and undernutrition and a surge of evidence on how to address the food security and nutrition dimensions of the epidemic. We review this evidence as well as the corresponding evolution of policy support for incorporating food security and nutrition concerns into HIV programming. The available evidence, although varied in scope and methodologies, shows that nutrition supplementation and safety nets in the form of food assistance and livelihood interventions have potential in certain contexts to improve food security and nutrition outcomes in an HIV/AIDS context. In the face of funding uncertainties and competing priorities, we must maintain momentum towards effective and sustainable solutions to the epidemic through continued systematic research to inform policy and through the strengthening of monitoring systems to dynamically inform intervention development. © 2014, Springer Science+Business Media New York. Source

Rawat R.,International Food Policy Research Institute | Faust E.,Middlebury College | Maluccio J.A.,Middlebury College | Kadiyala S.,London School of Hygiene and Tropical Medicine | Kadiyala S.,Leverhulme Center for Integrative Research on Agriculture and Health
Journal of Acquired Immune Deficiency Syndromes

BACKGROUND: Although the last decade has seen increased access to antiretroviral therapy across the developing world, widespread food insecurity and undernutrition continue to compromise an effective response to the AIDS epidemic. Limited evidence exists on the potential benefit of food security and nutrition interventions to people living with HIV (PLHIV). METHODS: We capitalized on an existing intervention to PLHIV in Uganda and conducted a prospective quasi-experimental study evaluating the impact of a monthly household food basket, provided to food insecure antiretroviral therapy-naive PLHIVs for 12 months. The outcomes of interest measured at baseline and follow-up were nutritional status [body mass index; mid-upper arm circumference and hemoglobin (Hb) concentrations], disease severity (CD4 count), and 2 measures of food security: diet quality (Individual Dietary Diversity Score) and food access (Household Food Insecurity Access Scale). We used difference-in-difference propensity score matching to examine the impact of food assistance. RESULTS: Over 12 months, food assistance significantly increased body mass index by 0.6 kg/m (P < 0.01) and mid-upper arm circumference by 6.7 mm (P < 0.05). We found no impact on CD4 count, Hb concentrations, or Individual Dietary Diversity Score. Restricting the analysis to individuals with CD4 counts of greater than 350 cells per microliter, there were significant impacts on Hb concentrations (1.0 g/dL; P < 0.05). At the household level, food assistance increased the Household Food Insecurity Access Scale, by 2.1 points (P < 0.01). CONCLUSIONS: This study demonstrates the potential for food assistance programming to be part of the standard of care for PLHIV in areas of widespread food insecurity. © 2013 by Lippincott Williams and Wilkins. Source

Cornelsen L.,London School of Hygiene and Tropical Medicine | Cornelsen L.,Leverhulme Center for Integrative Research on Agriculture and Health | Green R.,Leverhulme Center for Integrative Research on Agriculture and Health | Dangour A.,Leverhulme Center for Integrative Research on Agriculture and Health | Smith R.,Leverhulme Center for Integrative Research on Agriculture and Health
Journal of Public Health (United Kingdom)

Increasing prevalence of overweight and obesity has led policy-makers to consider health-related taxes to limit the consumption of unhealthy foods and beverages. Such taxes are currently already in place in countries in Europe (e.g. Hungary, France and Finland) and in various states in the USA. Although these taxes are possibly efficient in reducing by a small amount the consumption of targeted products if the tax is fully transmitted to the consumer, there is too little available evidence on what will be consumed instead and whether these food substitutions undermine the hoped-for health benefits of the tax. We also know very little on how the food supply side will respond and what overall impact this will have. Without a proper appreciation of the potential indirect impacts we do not know the overall impact of taxes foods on unhealthy foods and beverages and further that there is a very real possibility that they may not be beneficial for health after all. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. Source

Kadiyala S.,London School of Hygiene and Tropical Medicine | Kadiyala S.,Leverhulme Center for Integrative Research on Agriculture and Health | Harris J.,Leverhulme Center for Integrative Research on Agriculture and Health | Harris J.,International Food Policy Research Institute | And 3 more authors.
Annals of the New York Academy of Sciences

In India, progress against undernutrition has been slow. Given its importance for income generation, improving diets, care practices, and maternal health, the agriculture sector is widely regarded as playing an important role in accelerating the reduction in undernutrition. This paper comprehensively maps existing evidence along agriculture-nutrition pathways in India and assesses both the quality and coverage of the existing literature. We present a conceptual framework delineating six key pathways between agriculture and nutrition. Three pathways pertain to the nutritional impacts of farm production, farm incomes, and food prices. The other three pertain to agriculture-gender linkages. After an extensive search, we found 78 research papers that provided evidence to populate these pathways. The literature suggests that Indian agriculture has a range of important influences on nutrition. Agriculture seems to influence diets even when controlling for income, and relative food prices could partly explain observed dietary changes in recent decades. The evidence on agriculture-gender linkages to nutrition is relatively weak. Sizeable knowledge gaps remain. The root causes of these gaps include an interdisciplinary disconnect between nutrition and economics/agriculture, a related problem of inadequate survey data, and limited policy-driven experimentation. Closing these gaps is essential to strengthening the agriculture sector's contribution to reducing undernutrition. © 2014 The New York Academy of Sciences. Source

Hasler B.,Veterinary Epidemiology Economics and Public Health Group | Hasler B.,Leverhulme Center for Integrative Research on Agriculture and Health | Hiby E.,Conservation Research Ltd. | Gilbert W.,Veterinary Epidemiology Economics and Public Health Group | And 4 more authors.
PLoS Neglected Tropical Diseases

Background:One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its aication to zoonotic diseases is recommended, but few coherent frameworks exist that combine aoaches from multiple disciplines. Rabies requires an interdisciplinary aoach for effective and efficient management.Methodology/Principal Findings:A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is aied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method aoach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.Conclusions:The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control. © 2014 Häesler et al. Source

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