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

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Possible Mechanisms ofTransmissionAnti-HIV Activity in Breastmilk• M-cells serving as a gateway for the virusthrough epithelial lining• Enterocytes engulfing and transporting thevirus• Infected cells plus defective IgM• Lactoferrin• Sulfated protein thatinhibits binding of CD4 toHIV envelope•Other factorsRelative riskBreastfeeding Saves LivesRelative risk of infant mortality by mode of feeding1614.2141210864.543.62.12 1 10Exclusive BF BF+formula Formula onlyDiarrhea Acute respiratory infectionsSource: Victora et al 1987Infant Deaths (per 1000)HIV and Infant FeedingRisk AnalysisInfant mortality under different breastfeeding scenarios20015010050015243No BF amongHIV+AIDS deaths14595% BFamong HIV+184109 91138544620% spilloverNon-AIDS deathsSource: LINKAGES risk model 2001Breast Health in MalawiMTCT of HIV-1 byMode of Infant FeedingVariableLimited evidence3 months 15 months• Mastitis (breastmilkNa>12 mmol/L)• Maternal plasma logHIV load• Maternal CD4/CD8ration2.31 (1.25-4.26)1.71 (1.16-2.54)0.19 (0.06-0.54)Vertical Transmission (%)30252015105018.8 19.428.224.114.621.8Formula Mixed Exclusive BF (to3 m)Mode of Infant FeedingSource: WHO 1998Source: Coutsoudis et al 1999 (S.Africa); Ross 2002 (slide)
Estimated Risk of Post-natal HIVTransmissionBy infant age (Blantyre, Malawi)Age (months) %/monthTotalTiming the Introduction ofReplacement Feeding0-0.9 ??? ???1-5.9 0.7 3.5%6-11.9 0.6 3.6%12-17.9 0.3 1.8%18-23.9 0.2 1.2%1-23.9 10.1%Source: Miotti et al 1999; Piwoz 2001 (slide)Additionalrisk ofdeath00optimumAge (months)BreastfedNot breastfedSource: Ross 2002 (slide)Effect of Vitamin AMaternal vitamin A levels and MTCT of HIV- 1Vertical Transmission (%)353025201510501.40Serum Vitamin A (mmol/l)Source: Semba 1994 (Malawi); Ross 2002 (slide)Effect of Maternal Vitamin ALevels on MTCTSupplementation studies• Vitamin A had no effect on MTCT− South Africa (Coutsoudis et al 1999)− Tanzania (Fawzi)− Malawi (Semba)• But vitamin A reduced low birth weight inMalawi• Multiple micronutrients (but not vitamin A)reduced pre-term delivery in TanzaniaSource: Ross 2002 (slide)Ndola Demonstration ProjectIntegrated PMTCT ApproachNdola DistrictInformationand educationPolicyInfant feedingZAMBIAVoluntarycounseling andtestingCommunityMaternal and childhealth servicedeliveryPhoto: Tony Schwarzwalder
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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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HIV infection increases the energy
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Anemia is common during HIV infecti
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The use of high levels of supplemen
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Nutritional care and support for th
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Management of secondary infections
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A. Nutrition history• Dietary int
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• Income, housing, amenities for
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multiple nutrient supplement, where
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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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• 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
Page 278 and 279: Gelato, M. 2003. Insulin and carboh
Page 280 and 281: eferred him to the counselor for th
Page 282 and 283: Medication Purpose Recommended Tobe
Page 284 and 285: Medication Purpose Recommended Tobe
Page 286 and 287: Side effects of each drug?Side effe
Page 288 and 289: PurposeTo provide basic information
Page 290 and 291: Factors in Transmissionand Vulnerab
Page 292 and 293: Impact on the Education Sector• D
Page 294 and 295: AcknowledgmentNutrition and HIV/AID
Page 296 and 297: Body Habitus ChangesMetabolic chang
Page 298 and 299: PurposeTo provide general nutrition
Page 300 and 301: Stages of HIV Disease andNutritionI
Page 302 and 303: IncreaseVitamin and Mineral IntakeS
Page 304 and 305: Lipodystrophy• Means fat maldistr
Page 306 and 307: PurposeTo introduce the constraints
Page 308 and 309: Effect of AIDS on Crop ProductionCr
Page 310 and 311: Pregnant and Lactating WomenFood an
Page 312 and 313: Session 5 Nutritional Management of
Page 314 and 315: Rationale, Cont.Importance of Manag
Page 316 and 317: Session 6 Nutritional Care and Supp
Page 318 and 319: Vulnerabilityof Women and Young Gir
Page 320 and 321: What Is Not KnownComparison of Nutr
Page 322 and 323: Purposeof Nutrition Care and Suppor
Page 324 and 325: Greatest Impact of NutritionImprove
Page 326 and 327: Size of the Problem in Africa• >3
Page 330 and 331: Prevention-to-Care ContinuumInterve
Page 332 and 333: Session 8 Nutritional Care for Youn
Page 334 and 335: ChildrenBorn to HIV-Positive Mother
Page 336 and 337: Growth Failure Associated withIncre
Page 338 and 339: Enhanced ARV Therapy• To reduce v
Page 340 and 341: Care of the Terminally Ill ChildWhy
Page 342 and 343: PurposeTo provide knowledge and ski
Page 344 and 345: SIDE EFFECTS OF DRUGSaffectFOOD INT
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