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The Evolution of the Nutrition Assessment, Counseling & Support (NACS) Approach Tim Quick USAID Office of HIV/AIDS Co-Chair, PEPFAR Food & Nutrition Technical.

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Presentation on theme: "The Evolution of the Nutrition Assessment, Counseling & Support (NACS) Approach Tim Quick USAID Office of HIV/AIDS Co-Chair, PEPFAR Food & Nutrition Technical."— Presentation transcript:

1 The Evolution of the Nutrition Assessment, Counseling & Support (NACS) Approach Tim Quick USAID Office of HIV/AIDS Co-Chair, PEPFAR Food & Nutrition Technical Working Group AIDS 2012 - Turning the Tide Together

2 Slim disease: a new disease in Uganda and its association with HTLV-III infection Lancet 1985 Oct 19;2 (8460):849-52 D Serwadda, Nk Sewankambo, JW Carswell, AC Bayley, RS Tedder, RA Weiss, RD Mugerwa, A Lwegaba, GB Kirya, RG Downing, SA Clayden, & AG Dagleish

3 Malnutrition : Weakened immune system Increased susceptibility to opportunistic infections Wasting & increased mortality Poorer adherence & response to treatment HIV/AIDS: Loss of appetite Increased nutrient requirements Impaired nutrient absorption Altered nutrient metabolism

4 Nutrient requirements for people living with HIV/AIDS Report of a Technical Consultation World Health Organization Geneva, 13–15 May 2003

5 2005: WHO Consultation on Nutrition and HIV/AIDS in Africa calls for “the integration of nutrition into the essential package of care, treatment and support for people living with HIV/AIDS and efforts to prevent infection.” 2006: The World Health Assembly passes a resolution calling on Member States “to develop evidence-based policies and programs on HIV/AIDS and nutrition.”

6 Policy Guidance on the Use of Emergency Plan Funds to Address Food and Nutrition Needs September 2006 The Emergency Plan has a clear responsibility to support prevention, treatment and care for people living with HIV/AIDS (PLWHA), but comprehensively addressing issues of food insecurity is beyond the scope of the Emergency Plan. Key precepts of the Emergency Plan include remaining focused on HIV/AIDS, maximizing leverage with other partners that provide food resources and providing support for limited food assistance in defined circumstances.

7 Kenya Food by Prescription Program

8 Entry Points Assessment Counseling Clinical Mgmt PMTCT/ART Support Community Surveillance, Referral, Counseling & Support Clinic Community NACS -- Linking Clinics & Communities

9 Links vulnerable to clinical services -- reciprocal impact between health & nutrition Corrective  chronic nutrition mgmt -- continuum of care Link patients to support groups & community services Referrals for economic strengthening, livelihood & food security (ES/L/FS) support Health system strengthening -- NACS is a HSS approach to integrate nutrition within health services for all, not just PLHIV Clinics “anchor” nutrition support within communities Why NACS?

10 Fortification CMAM Zinc supplementation Growth monitoring & promotion Universal salt iodization PD Hearth Vitamin A supplementation Infant & Young child feeding Iron/FA supplementation Maternal nutrition

11 NACSNACS NACSNACS NACSNACS NACSNACS NACS Nutrition Assessment, Counseling & Support Establishing a Nutrition Standard of Care

12 Standard of Nutrition Care Continuum of Nutrition Care Assessment Counseling Support Infants & Young Children Women in Pregnancy & Postpartum Adults & Adolescents

13 Entry Points Assessment Counseling Clinical Mgmt Support Clinic NACS Household Economic Strengthening & Livelihood Support Promotion vocational training, IGAs, microcredit Protection household food production, savings Provision social grants, food assistance CBO Household Assessment & Service Referral Service Mapping Service Strengthening

14 NACS: A Life Cycle Approach Adulthood Birth Pregnancy Infancy Childhood Adolescence NACS

15 Birth PregnancyInfancyChildhoodAdolescenceAdulthood Linearizing the Life Cycle as a Continuum of Care

16 Birth PregnancyInfancyChildhoodAdolescenceAdulthood C & T ART & ARV Prophylaxis Tx of Malnutrition Maternal Nutrition & IYCF Counseling Photo: Wendy Hammond Photos: Wendy Hammond

17 Birth PregnancyInfancyChildhoodAdolescenceAdulthood ART & ARV Prophylaxis Peri-/Postnatal Care Maternal Nutrition & IYCF Counseling Photo: Wendy Hammond

18 Birth PregnancyInfancyChildhoodAdolescenceAdulthood Photos: Save the Children Federation Postnatal Care Deworming Micronutrients IYCF/GMP CMAM Tracking/Follow-Up of Mother-Infant Pairs

19 Birth PregnancyInfancyChildhoodAdolescenceAdulthood Photo of Plumpy’nut ® from Valid International; all others: Save the Children Federation Pediatric Care Nutrition Surveillance/GMP & Referral Micronutrients CMAM

20 Birth PregnancyInfancyChildhoodAdolescenceAdulthood Photo: LINKAGES Project Nutrition Surveillance, Referral, Assessment & Counseling Deworming Micronutrients CMAM Nutrition Surveillance, Referral, Assessment & Counseling Micronutrients Tx of malnutrition

21 Early Implementation Nigeria, DR Congo, Lesotho, Vietnam Program Expansion Côte d’Ivoire, Ghana, Ethiopia, Uganda, Tanzania, Mozambique Namibia, Zambia, South Africa, Haiti Implementation at National Scale Malawi and Kenya Phased Implementation of NACS

22 Partnership for HIV-free survival Six-country PMTCT initiative supported by a partnership under umbrella of IATT (Inter- Agency Task Team on Children and HIV/AIDS): Ministries of Health PEPFAR WHO UNICEF IHI MEASURE Evaluation FANTA-3 HCI Kenya Uganda Tanzania Mozambique South Africa Lesotho

23 Enabling Environment Policies, Strategies & Guidelines Training Research/M&E/HIS Supply Chain Management Quality Improvement Human Resources Funding/Financing Patient Referral & Tracking Mapping/Stre ngthening Referral Services NACS Community Demand


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