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

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Estimated time: 120 minutes excluding time for field workOutlineContent Methodology Timing1. Definition of terms and scope of theproblem• Meaning and scale of mother-to-childtransmission of HIV (MTCT), especiallyresulting from infant feeding• Infant feeding practices (countryspecificexamples)2. Risk analysis and factors for MTCT, withemphasis on the breastfeeding period• Size of risk and risk factors fortransmission of HIV during pregnancy,labor and delivery, and breastfeeding• Possible mechanisms of HIV transmissionduring breastfeeding (enabling factors,inhibitory factors, and colostrum)• Risk factors for breastfeeding and MTCT:viral load, maternal immune system,breast health, pattern and mode ofbreastfeeding, duration ofbreastfeeding, maternal nutritionalstatus, and child factors such as age andoral and intestinal health3. Interventions to prevent MTCT• Essential nutrition actions in ANC andVCT• Support for safer infant feedingpractices (modified exclusivebreastfeeding, exclusive replacementfeeding, other breastmilk options)• Short course antiretroviral (ARV)prophylaxis, optional obstetric care, andfamily planningFacilitate an interactivelecture using PowerPoint 7presentationDistribute Handout 7.1:WHO Recommendations onReplacement Feeding toReduce the Risk of MTCTand Handout 7.2: PMTCT-Infant Feeding Decision-Making AlgorithmFacilitate Exercise 7: Roleplay in pairs a healthworker counseling a motheror father on safer infantfeeding in HIV-prevalentcommunities (case studiesincluded)Distribute case study fromNdola, Zambia100minutes183
Required materials1. LCD or overhead projector2. Flipchart stand and paper or board3. Writing pens or chalkRecommended preparation1. Be familiar with Lecture Notes 7: Infant Feeding and PMTCT.2. Allocate time for each activity considering students’ backgrounds and coverageof the activity elsewhere.3. Prepare to divide the class into pairs for the role plays in Exercise 7: CounselingPregnant and Lactating Women in Areas of High HIV Prevalence.4. Change names for the role play as appropriate for the context. Modify the namesand any other aspects of the following case studies (e.g., foods described) asappropriate for country or community contexts.Materials providedPowerPoint Presentations• PowerPoint 7/overhead presentation: Infant Feeding and Prevention of Motherto-ChildTransmission (PMTCT) of HIVHandouts• PowerPoint 7 presentation• Handout 7.1: WHO Recommendations on Replacement Feeding to Reduce theRisk of MTCT• Handout 7.2: PMTCT-Infant Feeding Decision-Making Algorithm (including anexample from Uganda’s national PMTCT guidelines)184
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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
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Stages of illness and symptoms. Sym
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TherapyNitrogenretention[g/day]Rate
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Nutrient supplements for people liv
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Conclusion (slide 31)Nutritional ca
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HANDOUT 3.1 Case studies in HIV and
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HANDOUT 3.2 Safe Food Handling Prac
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OutlineContent Methodology Timing1.
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Recommended preparation• Be famil
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PVO-USAID Steering Committee on Mul
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Nutritional care and support of peo
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In this session “food security co
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HIV/AIDS attacks food security not
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• Human capital: Reduced producti
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Food-insecure populations may also
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Food security constraints to nutrit
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Pregnant and lactating women (slide
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Implementation of nutritional care
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demand these foods. A good assessme
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Counselors should be aware of and i
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Conclusion (slide 36)The capacity t
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UNAIDS and WHO. 2002. AIDS epidemic
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1. How does poor food availability
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5. Will referrals and targeting of
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SESSION 5 NUTRITIONAL MANAGEMENT OF
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Required materials• LCD or overhe
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LECTURE NOTES 5: NUTRITIONAL MANAGE
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Figure 2 Cycle of malnutrition and
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IV. Late symptomatic phase (full-bl
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The following symptoms may also neg
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• Enables greater food intake by
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EXERCISE 5=========================
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HANDOUT 5.1 Caring for symptoms ass
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Illness Diet Care and nutrition pra
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SESSION 6 NUTRITIONAL CARE AND SUPP
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Recommended preparation• Be famil
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———. 1998. Randomised trial o
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LECTURE NOTES 6: NUTRITIONAL CARE A
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The stigma associated with HIV can
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of malnutrition, which increases th
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adolescent mother, growth and devel
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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
Page 162 and 163: Infant feeding options and risks (s
Page 164 and 165: insecurity and may increase malnutr
Page 166 and 167: Seumo-Fosso, E, and B Cogill. 2003.
Page 168 and 169: HANDOUT 6.1 Health Sector and Mater
Page 170 and 171: HANDOUT 6.2 A Guide to Nutritional
Page 172 and 173: • Educational levelLactating moth
Page 174 and 175: Did the counselor ask about: YES NO
Page 176 and 177: HANDOUT 6.4 Practical Consideration
Page 178 and 179: HANDOUT 6.5 Checklist for Nutrition
Page 180 and 181: HANDOUT 6.7 Dietary Management of C
Page 182 and 183: Dietary problemFeverNutritional int
Page 184 and 185: 1. How could HIV infection affect R
Page 186 and 187: • Nutritional status, dietary int
Page 188 and 189: • Rita’s dietary intake and eat
Page 190 and 191: • Eating smaller, more frequent e
Page 192 and 193: • How was the nutritional assessm
Page 196 and 197: Suggested reading materialsCoutsoud
Page 198 and 199: LECTURE NOTES 7: INFANT FEEDING AND
Page 200 and 201: • A viral, bacterial, or parasiti
Page 202 and 203: DNA (cell-associated virus) in colo
Page 204 and 205: Mucosal integrity (slide 18)Studies
Page 206 and 207: PMTCT interventions are most effect
Page 208 and 209: Breastfeeding techniquesIt is espec
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Page 212 and 213: • Providing skin-to-skin contact
Page 214 and 215: suitable for replacement feeds befo
Page 216 and 217: • Administration of ZVD and Lamiv
Page 218 and 219: Coutsoudis, A, et al. 2001. Are HIV
Page 220 and 221: Semba, RD, N Kumwenda, D Hoover, et
Page 222 and 223: Case study 1A school teacher, Regin
Page 224 and 225: • How would you respond to Hilary
Page 226 and 227: HANDOUT 7.2 PMTCT Decision-Making A
Page 228 and 229: OutlineContent Methodology Time1. E
Page 230 and 231: Suggested reading materialsAgostoni
Page 232 and 233: LECTURE NOTES 8: NUTRITION AND HIV/
Page 234 and 235: Despite these statistics, it is dif
Page 236 and 237: Etiology of growth failure among HI
Page 238 and 239: oys. Micronutrient deficiencies wil
Page 240 and 241: • Changes in eating behaviors ass
Page 242 and 243: • 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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• 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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Nutrition and HIV/AIDS: A Training Manual - Linkages Project

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