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Session 7: Integrating Nutrition Assessment, Counselling, and Education into HIV and AIDS Care Nutrition Management with HIV and AIDS: Practical Tools.

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Presentation on theme: "Session 7: Integrating Nutrition Assessment, Counselling, and Education into HIV and AIDS Care Nutrition Management with HIV and AIDS: Practical Tools."— Presentation transcript:

1 Session 7: Integrating Nutrition Assessment, Counselling, and Education into HIV and AIDS Care Nutrition Management with HIV and AIDS: Practical Tools for Health Workers

2 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 2 Objectives Appropriately assess and counsel patients on nutrition and HIV Identify ways to integrate nutrition into HIV and AIDS care

3 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 3 Nutrition at Each Stage of HIV: Stage 1 Symptoms No other infections Generalised fatigue Nutrition Considerations Healthy eating and hydration (drink fluids) Nutrition assessment and education

4 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 4 Nutrition at Each Stage of HIV: Stage 2 Symptoms: Some other infections, but still in good overall health Weight loss (less than 10 percent of normal weight) Nutrition Considerations: Continue efforts for Stage 1 Follow-up nutrition assessment Address nutrition-related side effects Prevent weight loss Prescribe micronutrient supplements, if indicated

5 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 5 Nutrition at Each Stage of HIV: Stage 3 Symptoms: More serious infections Severe weight loss (greater than 10% loss of usual weight) Chronic, unexplained diarrhoea for > 1 month Unexplained anaemia Nutrition Considerations: Continue efforts for Stages 1 and 2 Nutrition management for: weight loss/malnutrition, ART, and infections Coping strategies

6 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 6 Nutrition at Each Stage of HIV: Stage 4 Symptoms: AIDS More serious infections with life-threatening complications HIV Wasting Syndrome Nutrition Considerations: Continue nutrition management of side effects, as appropriate for client’s prognosis Provide comfort and manage pain Fluids for hydration

7 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 7 Nutrition Assessment Anthropometric Biochemical Clinical Dietary Environmental Food Security

8 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 8 Anthropometrics Height (cm) at first visit for adults, at each visit for children Weight (kg) at each visit Percent weight loss, if applicable Mid Upper Arm Circumference (MUAC) at each visit Body Mass Index (BMI) at each visit

9 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 9 Weight Loss Calculation Percent weight loss UBW = Usual Body Weight CBW = Current Body Weight Formula: % loss = UBW – CBW x 100 UBW

10 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 10 Mid Upper Arm Circumference Use measuring tape; measure in cm Estimates muscle loss If less than 23 cm, possible muscle wasting  intervene with nutrition counselling

11 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 11 Body Mass Index (BMI) BMI is used to assess an adult’s weight based on their height. Not used for children or pregnant women A quick and easy way to estimate weight status (e.g. underweight, normal weight, overweight). Refer to BMI reference chart and calculation sheet

12 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 12 BMI Reference Chart Adapted from: RCQHC/FANTA

13 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 13 Biochemical Laboratory values as available CD4 count and all other routine values with: Blood cholesterol (fat) Blood glucose (sugar) Haemoglobin (blood iron) Urine test, look for ketones Parasites (e.g. worms)

14 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 14 Clinical Assess and counsel on management of complications Diarrhoea Nausea/vomiting Poor appetite Mouth sores Changes in taste Medication Regimen Discuss food effects, interactions, and herbal/traditional therapies

15 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 15 Dietary How many times a day does the client eat? What does the client eat in a typical day? How does the client: Keep foods cold (refrigerator, freezer, other methods)? Cook food (stove, open fire)? Keep dishes, utensils, and cooking areas clean (soap, water)?

16 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 16 Environmental Assess hygiene and sanitation situation at home and community Where does the family get water from? Is there a latrine in the home or communal latrine? If so, how is it maintained? Is garbage removed often and safely? Are client and family aware of basic food and water safety practices

17 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 17 Food Security Where does the food come from? Market, supermarket, home garden? Are there community or village gardening projects that client can be referred to? Know which local, nutritious foods are available in the community, and promote these instead of expensive foods from shops

18 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 18 Additional Information Other illness or opportunistic infections E.g. Tuberculosis, malaria, pneumonia, or skin problems Lifestyle practices (smoking, alcohol use, and unsafe sex) Family/community support system Educational level Living environment (housing, income, and number of members per household)

19 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 19 Anthropometric Measurement and BMI Calculation Practice

20 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 20 Nutrition Assessment Action Plan

21 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 21 Integration of Nutrition into HIV and AIDS Care Begin at VCT services Address food availability and access Weight loss prevention can improve survival

22 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 22 First HIV Visit Complete full nutrition assessment Obtain baseline height and weight, calculate BMI, and measure MUAC Ask about recent weight loss or inability to eat (due to illness) Ask about food availability, food storage, and cooking facilities in home Provide nutrition counselling on healthy eating

23 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 23 Follow-up Visits Continue with nutrition assessment Obtain height (if not already done), weight, calculate BMI, MUAC and % weight loss, if necessary Ask if any problems eating Ask if any change in food availability, storage or cooking facilities at home

24 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 24 For Patients in the Hospital Take note of whether the patient is eating and how much If the patient needs help and family members are not there, provide help with eating Weigh patients Counsel patient on adjusting food intake for management of side effects

25 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 25 Integration into ART Programme Before ART, assess food availability and intake situation Assess weight status Use Food and Medication Time Table when discussing medication schedule At each follow-up, obtain current weight and side effects Counsel appropriately on side effect management and good nutrition

26 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 26 Integration into PMTCT and Ongoing Paediatric Care Counsel mothers and partners on all infant feeding options for PMTCT Support infant feeding choice Educate on dangers of mixed feeding Monitor growth and feeding of infant For infants on replacement feeding, educate on and monitor formula/milk supply and preparation

27 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 27 Nutrition Counselling Listen to client; assess individual situation Ask open-ended questions (who, what, when, where, why, how?) Be realistic and practical with counselling; set realistic goals with client Encourage good eating habits Be a role model for clients Maintain confidentiality always

28 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 28 Making Suggestions, not Commands Commands use the imperative form of verbs (give, do, bring) and words like always, never, must, should Suggestions include: Have you considered …? Would it be possible …? What about trying … to see if it works for you? Would you be able to …?

29 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 29 Making Suggestions, not Commands Suggestions include: Have you thought about …? Instead of …? You could choose between … and … and … It may not suit you, but some mothers … a few women … Perhaps … might work Usually … Sometimes … Often … Follow-up with open-ended questions using: who, what, when, where, how, why

30 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 30 Counselling Role Play

31 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 31 Integration Case Study

32 Session 7: Integrating Nutrition into HIV and AIDS Care Nutrition Management with HIV and AIDS Training Slide 32 Key Points 1.All persons with HIV and AIDS need nutrition counselling and assessment 2.Obtain weight and calculate body mass index 3.Integrate nutrition and food security assessment into regular HIV care


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