Nutrition and HIV/AIDS: A Training Manual - Linkages Project

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LECTURE NOTES 5: NUTRITIONAL MANAGEMENT OF HIV/AIDS-RELATEDSYMPTOMS===============================================================IntroductionMalnutrition remains a public health challenge in resource-limited settings. Thereare various forms of malnutrition with complex and subtle causes. Malnutritionaffects all age groups in sub-Saharan Africa.Purpose (slide 2)The purpose of this session is to give students knowledge and skills for thenutritional management of HIV/AIDS-related symptoms. The session:• Discusses the appearance of HIV/AIDS-related symptoms in the progression ofthe disease• Describes the dietary management of HIV/AIDS related symptomsMalnutrition and infectionAs illustrated in figure 1, malnutrition increases vulnerability to and severity ofinfections, and infections aggravate malnutrition. Inadequate dietary intake leads tomalnutrition and lowered immune system function. Malnutrition reduces the body'sability to fight infections and therefore contributes to increased incidence, severity,and length of infections. Symptoms that accompany infections, such as loss ofappetite, diarrhea, and fever, lead to reduced food intake, malabsorption, nutrientlosses, and altered metabolism, which lead to weight loss, growth faltering, andfurther weakening of the immune system.101
Figure 1 Vicious cycle of malnutrition and infection-Weight loss-Growthfaltering-LoweredimmunityInadequatedietary intakeDiseases:-Incidence-Severity-Duration-Appetite loss-Nutrient loss-Malabsorption-AlteredmetabolismSource: Tomkins and Watson 1989In resource-limited settings, HIV infection is often contracted by people who mayalready be malnourished. Their lowered immune systems increase their vulnerabilityto infections.Relationship between nutrition and HIV/AIDS (slide 4)HIV infection has long been recognized to have a possible negative impact on thenutritional status of people living with HIV/AIDS and lead to malnutrition. Therelationship between HIV/AIDS and malnutrition is a classic example of the viciouscycle of immune dysfunction, infectious diseases, and malnutrition. As illustrated infigure 2, malnutrition can weaken the immune system and increase vulnerability toinfections, and may speed up the progression of the disease.102
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Regional Centrefor Quality ofHealth
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ACKNOWLEDGMENTSThis training manual
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ABBREVIATIONS AND ACRONYMSACCAIDSAN
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INTRODUCTIONThe coexistence of high
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ContentThe content is arranged in t
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The sessions can also be taught in
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OutlineContent Methodology TimingDe
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LECTURE NOTES 1: THE BASICS OF HIV/
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gradually weakened. The infected pe
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increase in HIV prevalence of 60 pe
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infection may have a rapid onset, l
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• Dot-blot immunobinding assayUri
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• Removal of children from school
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effectively, care and support inter
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DISCUSSION POINTS 1================
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Recommended preparation1. Be famili
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LECTURE NOTES 2: LINK BETWEEN NUTRI
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AIDS, the impairment of immune func
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for healthy, non-HIV-infected peopl
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Low blood levels of several nutrien
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• Finally, a study of AIDS patien
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EXERCISE 2=========================
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SESSION 3 NUTRITION ACTIONS FOR PEO
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Required materials• LCD or overhe
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McDermott, AY, A Shevitz, T Knox, R
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Goals of nutritional care and suppo
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• Circumferences of the waist, hi
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Consider the phase of the HIV infec
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Promote adequate nutrient intake (s
Page 62 and 63: Stages of illness and symptoms. Sym
Page 64 and 65: TherapyNitrogenretention[g/day]Rate
Page 66 and 67: Nutrient supplements for people liv
Page 68 and 69: Conclusion (slide 31)Nutritional ca
Page 70 and 71: HANDOUT 3.1 Case studies in HIV and
Page 72 and 73: HANDOUT 3.2 Safe Food Handling Prac
Page 74 and 75: OutlineContent Methodology Timing1.
Page 76 and 77: Recommended preparation• Be famil
Page 78 and 79: PVO-USAID Steering Committee on Mul
Page 80 and 81: Nutritional care and support of peo
Page 82 and 83: In this session “food security co
Page 84 and 85: HIV/AIDS attacks food security not
Page 86 and 87: • Human capital: Reduced producti
Page 88 and 89: Food-insecure populations may also
Page 90 and 91: Food security constraints to nutrit
Page 92 and 93: Pregnant and lactating women (slide
Page 94 and 95: Implementation of nutritional care
Page 96 and 97: demand these foods. A good assessme
Page 98 and 99: Counselors should be aware of and i
Page 100 and 101: Conclusion (slide 36)The capacity t
Page 102 and 103: UNAIDS and WHO. 2002. AIDS epidemic
Page 104 and 105: 1. How does poor food availability
Page 106 and 107: 5. Will referrals and targeting of
Page 108 and 109: SESSION 5 NUTRITIONAL MANAGEMENT OF
Page 110 and 111: Required materials• LCD or overhe
Page 114 and 115: Figure 2 Cycle of malnutrition and
Page 116 and 117: IV. Late symptomatic phase (full-bl
Page 118 and 119: The following symptoms may also neg
Page 120 and 121: • Enables greater food intake by
Page 122 and 123: EXERCISE 5=========================
Page 124 and 125: HANDOUT 5.1 Caring for symptoms ass
Page 126 and 127: Illness Diet Care and nutrition pra
Page 128 and 129: SESSION 6 NUTRITIONAL CARE AND SUPP
Page 130 and 131: OutlineContent Methodology Timing1.
Page 132 and 133: Recommended preparation• Be famil
Page 134 and 135: ———. 1998. Randomised trial o
Page 136 and 137: LECTURE NOTES 6: NUTRITIONAL CARE A
Page 138 and 139: The stigma associated with HIV can
Page 140 and 141: of malnutrition, which increases th
Page 142 and 143: adolescent mother, growth and devel
Page 144 and 145: HIV infection increases the energy
Page 146 and 147: Anemia is common during HIV infecti
Page 148 and 149: The use of high levels of supplemen
Page 150 and 151: Nutritional care and support for th
Page 152 and 153: Management of secondary infections
Page 154 and 155: A. Nutrition history• Dietary int
Page 156 and 157: • Income, housing, amenities for
Page 158 and 159: multiple nutrient supplement, where
Page 160 and 161: Management of diet-related HIV prob
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Infant feeding options and risks (s
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insecurity and may increase malnutr
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Seumo-Fosso, E, and B Cogill. 2003.
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HANDOUT 6.1 Health Sector and Mater
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HANDOUT 6.2 A Guide to Nutritional
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• Educational levelLactating moth
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Did the counselor ask about: YES NO
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HANDOUT 6.4 Practical Consideration
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HANDOUT 6.5 Checklist for Nutrition
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HANDOUT 6.7 Dietary Management of C
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Dietary problemFeverNutritional int
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1. How could HIV infection affect R
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• Nutritional status, dietary int
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• Rita’s dietary intake and eat
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• Eating smaller, more frequent e
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• How was the nutritional assessm
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Estimated time: 120 minutes excludi
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Suggested reading materialsCoutsoud
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LECTURE NOTES 7: INFANT FEEDING AND
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• A viral, bacterial, or parasiti
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DNA (cell-associated virus) in colo
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Mucosal integrity (slide 18)Studies
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PMTCT interventions are most effect
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Breastfeeding techniquesIt is espec
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women with HIV/AIDS for additional
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• Providing skin-to-skin contact
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suitable for replacement feeds befo
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• Administration of ZVD and Lamiv
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Coutsoudis, A, et al. 2001. Are HIV
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Semba, RD, N Kumwenda, D Hoover, et
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Case study 1A school teacher, Regin
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• How would you respond to Hilary
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HANDOUT 7.2 PMTCT Decision-Making A
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OutlineContent Methodology Time1. E
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Suggested reading materialsAgostoni
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LECTURE NOTES 8: NUTRITION AND HIV/
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Despite these statistics, it is dif
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Etiology of growth failure among HI
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oys. Micronutrient deficiencies wil
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• Changes in eating behaviors ass
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• Address issues relevant and of
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Enhanced ARV therapy (slide 29)Chil
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• Refer children with severe maln
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DISCUSSION POINTS 8Questions for cl
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Action/activityNorman admitted to n
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OutlineContent Methodology Timing1.
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• Allocate time for each activity
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Food Medication Interactionswww.foo
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• Describes information collected
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• Antimalaria drugs such as quini
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Food effects on drug efficacy (slid
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Some antiretroviral drugs may affec
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MedicationPurposeRecommended Tobe t
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intake and poor nutrient absorption
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Anti-acid medications containing ma
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women’s nutritional status. It is
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Health provider capacityHealth prov
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• What foods should not be taken
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Gelato, M. 2003. Insulin and carboh
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eferred him to the counselor for th
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Medication Purpose Recommended Tobe
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Medication Purpose Recommended Tobe
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Side effects of each drug?Side effe
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PurposeTo provide basic information
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Factors in Transmissionand Vulnerab
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Impact on the Education Sector• D
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AcknowledgmentNutrition and HIV/AID
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Body Habitus ChangesMetabolic chang
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PurposeTo provide general nutrition
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Stages of HIV Disease andNutritionI
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IncreaseVitamin and Mineral IntakeS
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Lipodystrophy• Means fat maldistr
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PurposeTo introduce the constraints
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Effect of AIDS on Crop ProductionCr
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Pregnant and Lactating WomenFood an
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Session 5 Nutritional Management of
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Rationale, Cont.Importance of Manag
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Session 6 Nutritional Care and Supp
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Vulnerabilityof Women and Young Gir
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What Is Not KnownComparison of Nutr
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Purposeof Nutrition Care and Suppor
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Greatest Impact of NutritionImprove
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Size of the Problem in Africa• >3
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Possible Mechanisms ofTransmissionA
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Prevention-to-Care ContinuumInterve
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Session 8 Nutritional Care for Youn
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ChildrenBorn to HIV-Positive Mother
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Growth Failure Associated withIncre
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Enhanced ARV Therapy• To reduce v
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Care of the Terminally Ill ChildWhy
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PurposeTo provide knowledge and ski
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SIDE EFFECTS OF DRUGSaffectFOOD INT
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