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Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Guides and Resources for Training HIV/AIDS Providers Marcy Fenton MS RD Nutritionist,

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Presentation on theme: "Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Guides and Resources for Training HIV/AIDS Providers Marcy Fenton MS RD Nutritionist,"— Presentation transcript:

1 Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Guides and Resources for Training HIV/AIDS Providers Marcy Fenton MS RD Nutritionist, AIDS Project Los Angeles Education Committee Co-Chair, HIV/AIDS Dietetic Practice Group, American Dietetic Association mfenton@apla.org Barbara Scott, MPH, RD Associate Professor, University of Nevada School of Medicine, AETC, Reno, NV Education Committee Member, HIV/AIDS Dietetic Practice Group, American Dietetic Association scottbj@med.unr.edu

2 Pacfic AETC 2003 Asilomar Faculty Development Conference Learning Objectives zRecognize the benefits of incorporating training on nutrition into the AETC curricula zBecome familiar with qualifications of HIV Nutrition Providers/Trainers zKnow how to access excellent nutrition trainers and use HIV nutrition guidelines and resources in AETC training zUnderstand comprehensive range of topics for nutrition training curricula zIncrease support for adding dietitians as targeted AETC trainees

3 Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition is Important to Include in AETC Training because…...

4 Pacfic AETC 2003 Asilomar Faculty Development Conference Poor Nutrition Can... zContribute to impaired immune response; zResult in more rapid disease progression & shortened survival; zContribute to increased frequency and severity of infections; zResult in fatigue, loss of appetite, sense of taste and smell, and decreased quality of life; zIncrease utilization of health care resources; zDecrease tolerance to therapy and lessen medication efficacy; and zBe prevented in many cases with frequent monitoring and early individualized and persistent treatment.

5 Pacfic AETC 2003 Asilomar Faculty Development Conference Medical Nutrition Therapy can... zOptimize nutrition status, immunity and overall well being zPrevent the development of specific nutrient deficiencies zPrevent loss of weight and lean body mass zReduce risk for onset or complications of co-morbidities (e.g., diabetes, cardiovascular, osteoporosis, kidney & liver diseases) zMaximize effectiveness of medical and pharmacological treatments zMinimize health care costs

6 Pacfic AETC 2003 Asilomar Faculty Development Conference Qualified HIV Nutrition Providers Can Provide AETC Training...

7 Pacfic AETC 2003 Asilomar Faculty Development Conference National Network of Dietitians: zMembers of the HIV/AIDS Dietetic Practice Group of the American Dietetic Association www.hivaidsdpg.org www.hivaidsdpg.org zMany are also members of Association of Nutrition Services Agencies www.aidsnutrition.org www.aidsnutrition.org zAll are educated in nutrition sciences: 4 year degree + internship), Registered Dietitian (RD) zMost specialize in HIV/AIDS and love working with patients and teaching

8 Pacfic AETC 2003 Asilomar Faculty Development Conference AETCs Can Help Train More Qualified Nutrition Providers

9 Pacfic AETC 2003 Asilomar Faculty Development Conference Training for New HIV Nutrition Providers zLink with HIV/AIDS Dietetic Practice Group trainers to design, provide, and evaluate nutrition training zTrain AETC targeted providers and Medical Team Members (Physician, Physician Assistant, Nurse Practitioner, Registered Nurse, Social Worker, Pharmacist, Dentist, Mental Health Counselor) to hire and support (ex: reasonable patient load: 250-500 clients/1 FTE) qualified nutrition providers for their clinics zSupport ongoing training for HIV Nutritionists/Dietitians yAPLA 4-day Nutrition in HIV Care Education & Training 2/9-12/2004 yANSA annual meeting yUpdates: HIV medical, pharmacology, nutrition

10 Pacfic AETC 2003 Asilomar Faculty Development Conference Many Resources Are Available to Guide Nutrition Training…..

11 Pacfic AETC 2003 Asilomar Faculty Development Conference Health Care and HIV: Nutritional Guide for Providers and Clients 2nd Ed. 2002. HRSA/HAB, http://www.aids- etc.org/aidsetc?page=et-30-20-01 z265 page manual (PDF files) yGuidance for health care providers yPatient handouts ySome sections in Spanish yAlgorithms for care yReferences

12 Pacfic AETC 2003 Asilomar Faculty Development Conference zIntegrating Nutrition Therapy into Medical Management of Human Immunodeficiency Virus Clin Infect Dis vol 36 suppl 2 Apr 2003 http://www.journals.uchicago.edu/CID/jou rnal/contents/v36nS2.html http://www.journals.uchicago.edu/CID/jou rnal/contents/v36nS2.html zNutrition Guidelines for Agencies Providing Food to People Living with HIV Disease, 2 nd Ed. AIDS Nutrition Services Alliance (ANSA, now called Association of Nutrition Services Agencies) www.aidsnutrition.orgwww.aidsnutrition.org

13 Pacfic AETC 2003 Asilomar Faculty Development Conference zGuidelines for Implementing HIV/AIDS Medical Nutrition Therapy Protocols, Los Angeles County Commission on HIV Health Services, 1999 http://www.numedx.com/readstory.phtml?story =v2n3feature http://www.numedx.com/readstory.phtml?story =v2n3feature zHIV/AIDS Adults Medical Nutrition Therapy Protocol (ADA, Medical Nutrition Therapy Across the Continuum of Care, 1998) www.aids- etc.org/aidsetc?page=et-30-20-01www.aids- etc.org/aidsetc?page=et-30-20-01 zHIV/AIDS Children/Adolescents Medical Nutrition Therapy Protocol (ADA, Medical Nutrition Therapy Across the Continuum of Care, 1998) www.aids-etc.org/aidsetc?page=et-30-20-01 www.aids-etc.org/aidsetc?page=et-30-20-01

14 Pacfic AETC 2003 Asilomar Faculty Development Conference zPosition of the American Dietetic Association and Dietitians of Canada: Nutrition intervention in the care of persons with human immunodeficiency virus. J Am Diet Assoc 2000;100:708-717 http://www.eatright.org/Public/ GovernmentAffairs/92_adap0600.cfm http://www.eatright.org/Public/ GovernmentAffairs/92_adap0600.cfm zHepatitis C: Nutrition Care, Canadian Guidelines for Health Care Providers Dietitians of Canada, 2003 http://www.dietitians.ca/resources/Hepati tisC_Guidelines.htm http://www.dietitians.ca/resources/Hepati tisC_Guidelines.htm

15 Pacfic AETC 2003 Asilomar Faculty Development Conference Anticipated resources zHIV/AIDS Medical Nutrition Therapy Protocols (Adult and Children) revisions (ADA) are expected in October, 2003 www.eatright.org www.eatright.org zHIV/AIDS Medical Nutrition Therapy Evidence-Based Guides (ADA) are under development

16 Pacfic AETC 2003 Asilomar Faculty Development Conference Suggestions for Nutrition Training Content

17 Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Education & Counseling for All Patients Rights of clients: To have early & ongoing access to medical nutrition therapy in a time & location convenient to where medical services are received To have a provider of medical nutrition therapy who is a qualified, HIV-knowledgeable, and capable dietetics practitioner To refuse medical nutrition therapy That the environment safeguards & maintains their confidentiality Guidelines for Implementing HIV/AIDS Medical Nutrition Therapy Protocols, Los Angeles County Commission on HIV Health Services, 1999 Guidelines (text) http://www.numedx.com/readstory.phtml?story=v2n3featurehttp://www.numedx.com/readstory.phtml?story=v2n3feature

18 Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Education & Counseling for All Patients Topic areas include: zFood & water safety and sanitation zMaintenance of weight and lean body mass; normal growth in children zHow to select foods for a healthful balanced diet zFood sources of important nutrients zDietary and nutritional supplement use zAnticipatory guidance and intervention in difficult times: diarrhea, nausea, fatigue, weight loss, other problems.

19 Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Education & Counseling for All Patients Topic areas include (continued): zRole of exercise zNutrition during pregnancy zAccess to infant formula and food as an alternative to breast-feeding zRole of nutrition in: ymaintenance of immune function; ymaintenance of organ function; ywound healing; ymedication or treatment efficacy; yprevention/treatment of chronic disease

20 Pacfic AETC 2003 Asilomar Faculty Development Conference Nutrition Screen & Referral Criteria for Adults zScreen every 6 months &/or at status change. zCategories for automatic referral to a registered dietitian: yDiagnosis and nutrition assessment yPhysical changes and weight concerns yOral/GI symptoms yMetabolic complications & other medical conditions yBarriers to nutrition, living environment, functional status yBehavioral concerns or unusual eating behaviors http://www.hivaidsdpg.org/Data/QM/HIV Adult_Nutrition_Screen_Referral_Criteria_200207.pdf http://www.hivaidsdpg.org/Data/QM/HIV Adult_Nutrition_Screen_Referral_Criteria_200207.pdf www.aahivm.org zNutrition is part of primary medical care

21 Pacfic AETC 2003 Asilomar Faculty Development Conference Positions z….efforts to optimize nutritional status, including medical nutrition therapy and nutrition education, should be components of the total health care provided to people infected with human immunodeficiency virus. J Am Diet Assoc. 2000;100:708-717 (Expires 2003) ADA and Dietitians or Canada Joint Position. www.eatright.org/Public/GovernmentAffairs/92_adap0600.cfm www.eatright.org/Public/GovernmentAffairs/92_adap0600.cfm zPatients should be entered into a continuum of medical care and services, including social, psychosocial, and nutritional services, with the availability of professional referral and consultation. Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents, July 14, 2003 www.aidsinfo.nih.gov/guidelines/adult/AA_071403.pdf www.aidsinfo.nih.gov/guidelines/adult/AA_071403.pdf

22 Pacfic AETC 2003 Asilomar Faculty Development Conference Access to Medical Nutrition Therapy Ryan White CARE Act yTitle I: xSupports food services Home-delivered meals, food banks, nutritional supplements: The provision of actual food, meals, or nutritional supplements. It does not include finances to purchase food or meals. The provision of essential household supplies such as hygiene items and household cleaning supplies should be included in this item. xOther Outpatient/Community-Based Primary Medical Care Services Provision of nutrition education and/or counseling provided by a licensed/registered dietitian outside of a primary care visit. Nutritional counseling provided by other than a licensed/registered dietitian should be provided under psychosocial support services.

23 Pacfic AETC 2003 Asilomar Faculty Development Conference Access to Medical Nutrition Therapy Ryan White CARE Act (cont.) yAIDS Drug Assistance Program (ADAP) xSome require nutrition-related documentation for growth hormone, other anabolic agents, not specifying counseling xSome pay for nutritional supplements yTitle II xIncludes funds for primary and supportive services, which includes nutrition and meal/food and supplements. yTitle III (Early Intervention Services) xNutritional services, considered a primary care service, must be provided to all persons living with HIV/AIDS whether on site or at another facility either directly or through a formal referral mechanism. xNutritional services include dietary/nutritional evaluation, nutritional supplements and nutrition education or counseling optimally provided by a licensed registered dietitian or nutritionist.

24 Pacfic AETC 2003 Asilomar Faculty Development Conference Access to Medical Nutrition Therapy Medicare yDiabetes, Renal (pre-renal) – 1999 legislation, coverage started 2001 yCenters for Medicare & Medicaid Services (CMS) report due 6/03 to Congress re: xCardiovascular disease (HR1225 / S 632) xMay recommend expansion to HIV, cancer, osteoporosis, others. xIf recommendation: Bill will be introduced & your support is needed Possibly all conditions with physician Rx will be covered yAmerican Dietetic Association with HIV/AIDS Dietetic Practice Group is educating Congress on unique nutritional needs of HIV disease

25 Pacfic AETC 2003 Asilomar Faculty Development Conference Access to Medical Nutrition Therapy Medicaid yLimited: Washington DC, Georgia, Some state Medicaid home health waiver programs ySome pay for nutritional supplements Private, HMOs, VA yIrregular, many to mostly not covered yBlue Cross of Massachusetts since 1996 HIV/AIDS MNT Protocol Prisons yIrregular - often lack individualized nutrition care Hospitalizations yUsually nutrition coverage

26 Pacfic AETC 2003 Asilomar Faculty Development Conference HIV Medications & Nutrition zRestrictions and challenges of taking medications: yGenerally: education, reinforcement, support adherence ySpecifically: food, meal, fluids, timing & schedule, pill burden zSide effects management yDiarrhea, nausea, anorexia, fatigue, chewing/swallowing/dental, bloating, heartburn, change in taste/smells, fat maldistribution metabolic complications (insulin, glucose, lipids, bone), others zAdvocate for: yClearer nutrition-medication educational materials xPHS standard of care guidelines, package inserts, in clinics yClinical research to refine PHS Guidelines for nutrition (NORA) xTaking with and without food, fluid, side effects management, nutrient and nutritional status including body composition

27 Pacfic AETC 2003 Asilomar Faculty Development Conference Need for Food Resources zQuestions of quality, quantity and financial and physical accessibility zFood and Meal Providers yAssociation of Nutrition Services Agencies www.aidsnutrition.orgwww.aidsnutrition.org yLocal ASOs, ANSA members, meals-on-wheels, farmers markets yFood Stamps, Women, Infants & Children Program, School Lunch Program, School Breakfast Program, etc. www.usda.gov www.usda.gov zCollaborate with anti-hunger organizations yNational: xCommunity Food Security Coalition www.foodsecurity.org www.foodsecurity.org xFood Research & Action Center (FRAC) 202-986-2200 www.frac.org www.frac.org yLocal

28 Pacfic AETC 2003 Asilomar Faculty Development Conference Additional HIV Nutrition Resources

29 Pacfic AETC 2003 Asilomar Faculty Development Conference zAIDS Project Los Angeles, HIV Nutrition Education Program www.apla.orgwww.apla.org zHIV Resources www.hivresources.orgwww.hivresources.org zHIV Fitness Guidelines www.hivfitness.orgwww.hivfitness.org zAssociation of Nutrition Services Agencies www.aidsnutrition.com www.aidsnutrition.com zPositive Communication 4 issues @ $30/year www.hivaidsdpg.org www.hivaidsdpg.org zTufts University Health & Nutrition Letter www.healthletter.tufts.edu www.healthletter.tufts.edu zThe Body www.thebody.comwww.thebody.com zNumedx www.numedx.comwww.numedx.com

30 Pacfic AETC 2003 Asilomar Faculty Development Conference Thank You for Your Attention!


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