The authors assessed whether livelihood interventions integrated with HIV and AIDS care and treatment programmes share a clearly elucidated causal pathway to impact, and examined their service delivery and utilisation plans to realise intended impacts on food security. They conducted multiple in-depth key informant interviews, along the livelihood programme chain, with staff from the AIDS Support Organisation and 16 collaborating partners implementing livelihood programmes in eastern and northern Uganda. They present their results using a programme theory framework, highlighting the quality of conceptualisation of programme impact pathways by programme staff, and identify key steps along the process pathway as they relate to successful delivery of interventions, programme participation, and uptake of services by beneficiaries. Key research questions include the following: Do programmes possess coherent, consistent and plausible objectives and approaches to attaining them? Are the impact and process theories clearly defined and logical? Through analysis of programme staff interviews, the authors highlight critical gaps in conceptualisation of causal pathways and programme processes that need to be addressed in order to maximise programme impact.