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Tim Quick USAID Office of HIV/AIDS

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Presentation on theme: "Tim Quick USAID Office of HIV/AIDS"— 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

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

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 by Prescription Program
Kenya Food by Prescription Program

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

9 Why NACS? 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

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

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

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

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

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

15 Linearizing the Life Cycle as a Continuum of Care
Birth Pregnancy Infancy Childhood Adolescence Adulthood

16 C & T ART & ARV Prophylaxis Tx of Malnutrition Maternal Nutrition &
Photo: Wendy Hammond Photos: Wendy Hammond C & T ART & ARV Prophylaxis Tx of Malnutrition Maternal Nutrition & IYCF Counseling Birth Pregnancy Infancy Childhood Adolescence Adulthood

17 ART & ARV Prophylaxis Peri-/Postnatal Care Maternal Nutrition &
Photo: Wendy Hammond ART & ARV Prophylaxis Peri-/Postnatal Care Maternal Nutrition & IYCF Counseling Birth Pregnancy Infancy Childhood Adolescence Adulthood

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

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

20 Nutrition Surveillance, Referral, Assessment & Counseling
Deworming Micronutrients CMAM Nutrition Surveillance, Referral, Assessment & Counseling Micronutrients Tx of malnutrition Photo: LINKAGES Project Birth Pregnancy Infancy Childhood Adolescence Adulthood

21 Phased Implementation of NACS
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

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

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