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

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Prevention-to-Care ContinuumInterventionsto Reduce MTCTPregnancy Labor and delivery Post-natal periodPrimarypreventionof HIV/AIDSin adultsCoreinterventionsto preventMTCTCare andsupport•Provide VCT•Provide primaryprevention•Prevent, monitor,treat STIs, malaria,other infections•Provide essential ANC,including nutritionsupport•Provide ARVs•Counsel on safer sex,partner involvement,infant feeding options,family planning, selfcare,preparing for thefuture•ARVs•Keep normal•Minimize invasiveprocedures:AROMEpisiotomySuctioning• Elective C-Section•Vaginal cleansing•Minimize infantexposure tomaternal fluids•Implement BFHI•Initiate early BF•Support exclusive BF•Prevent and treatbreastfeeding problemsOr If choice:• Support replacementfeeding•Provide care for thrushand oral lesions•Counsel oncomplementaryfeeding/early weaning• Provide ARVsSource: Piwoz 2001 (slide)Nutrition EssentialsNutrition Essentials, Cont.1. Promotion of optimal breastfeeding during thefirst 6 months2. Promotion of appropriate complementaryfeeding beginning at 6 months, with continuedbreastfeeding to 2 years and beyond3. Promotion of feeding of the child during andafter illness4. Prevention of vitamin A deficiency(breastfeeding, consumption of fortified andvitamin A-rich foods, maternal and childsupplementation 6-59 months)5. Prevention of anemia (maternal and child ironsupplementation, deworming, malaria control,consumption of fortified and iron-rich foods)6. Promotion of iodized salt consumption by allfamilies7. Promotion of improved women’s nutrition(increased food intake during pregnancy andlactation, iron and folic acid supplementation,treatment and prevention of malaria,deworming during pregnancy, post-partumvitamin A supplementation)VCT and MTCTInformed Choice• Confidentiality assured• Community sensitization and support• Health workers trained in MTCT• Counseling programs (peer counselors, healthand social workers)• Prevention messages included“HIV and breastfeeding policy supportsbreastfeeding for infants of womenwithout HIV infection or of unknownstatus and the right of a woman infectedwith HIV who is informed of her serostatusto choose an infant feedingstrategy based on full information aboutthe risks and benefits of eachalternative.”UNAIDS/WHO/UNICEF
Infant Feeding CounselingConditions forSafe Replacement Feeding•Clean waterHIV statusunknown•Prevention• EBF•VCT counseling• ComplementaryfeedingHIV -• Prevention• EBF• VCT counseling• ComplementaryfeedingHIV +•Prevention• Feeding options: EBF,early cessation,replacement feeding• Complementaryfeeding• BF problems treatment• Sterilized utensils• Steady supply of commercial or homepreparedformula to meet all the infant’snutritional needs• AntiretroviralsARV Courses for PMTCTPMTCT Expansion in ZambiaZidovudine (ZVD) to mother from 36 monthsgestation through labor and delivery, withadditional prophylaxis to mother after birth in someregimensZVD and lamivudine (3TC) to mother and babyduring antenatal, intrapartum, and postpartumperiodsNevirapine (NVP) during labor and to infant within 72hours of birth.Ndola (190,000)Kabwe (48,415)LusakaNdola North(210,076)MtendereLivingstone (25,685)NDP Indicators and Results1. Exclusive breastfeeding rate (EBR) ofinfants 0-
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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
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Gelato, M. 2003. Insulin and carboh
Page 280 and 281: eferred him to the counselor for th
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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 328 and 329: Possible Mechanisms ofTransmissionA
Page 332 and 333: Session 8 Nutritional Care for Youn
Page 334 and 335: ChildrenBorn to HIV-Positive Mother
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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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