A Guide to Monitoring and Evaluation of Nutrition Assessment, Education and Counseling of People Living with HIV

This guide provides guidance and tools to support programmes engaging in monitoring and evaluation (M&E) of nutrition assessment, education and counselling (NAEC) for people living with HIV (PLHIV). It is designed for use by programme managers, M&E officers, and other programme and government health system staff who recognise the multifaceted and multidirectional relationship between HIV and nutrition: HIV can cause or worsen malnutrition due to decreased food intake, increased energy requirements, and poor nutrient absorption. Malnutrition in turn further weakens the immune system, increasing susceptibility to infections and worsening the disease's impact.

The conceptual framework on which the guide is built depicts the process of how food and nutrition interventions improve the health and nutritional status of PLHIV. It is arranged in terms of the implementation stages used for M&E: inputs, processes, outputs, outcomes, and impacts. This framework can be used to select indicators that are feasible and appropriate for programme activities, set targets, plan data collection and tabulation processes, and interpret and use the information obtained. The data collection tools at the end of the guide can be used to collect data to measure the indicators selected or can be adapted to specific programme requirements and record-keeping systems.

Following several introductory sections, the guide is organised as follows: Section 3 presents a conceptual framework for food and nutrition interventions. Section 4 describes NAEC for PLHIV. Section 5 describes uses of M&E information, and Section 6 lays out the steps involved in planning M&E of NAEC. Section 7 describes some of the challenges facing M&E of NAEC. Section 8 presents detailed information on 14 core indicators for NAEC and how to apply them. Appendix 2 offers a full list of possible indicators, and the other appendices provide additional information on specific topics. Sample data collection tools may be found in Appendix 5.

In short, the framework illustrates how livelihood-strengthening activities, food assistance, micronutrient supplements, and - in particular - NAEC lead to changes in knowledge and availability of resources at the individual and household levels, which in turn influence dietary practices and food access. Dietary practices and food access affect the health and nutritional status of PLHIV through dietary intake and health-related factors (e.g., immune response, frequency and severity of infections and symptoms, response to medical treatment).

The guide is a product of the Food and Nutrition Technical Assistance (FANTA) Project, which is managed by the Academy for Educational Development (AED) and supported by the Office of Health, Infectious Disease, and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID).