Comprehensive Nutrition Care for People Living with HIV/AIDS

238 Pages·2010·19.12 MB·English

Comprehensive Nutrition Care
for People Living with HIV/AIDS
A Trainers Manual for Facility-Based Health Providers
Comprehensive Nutrition Care
for People Living with HIV/AIDS
A Trainers Manual for Facility-Based Health Providers
Financial support for this interim training manual was provided by USAID, Cooperative Agreement number
617-A-00-08-00006-00. The views expressed in this document do not necessarily refect those of USAID.
NuLife is implemented by University Research Co., LLC, (URC) in collaboration with Save the Children U.S.A.
and ACDI/VOCA.
Table of
Contents
Acronyms ii
Review of facilitation techiques iv
Session 1: Basics Of Nutrition 1
Session 2: Infant And Young Child Feeding 11
Session 3: Overview Of Infant & Young Child Feeding In The Context Of HIV 25
Session 4: Feeding Children During Illness, Recovery And Diffcult Circumstances 33
Session 5: Overview Of HIV/AIDS 47
Session 6: Introduction To Malnutrition 55
Session 7: Interaction Between HIV & Nutrition 79
Session 8: Integrated Management Of Acute Malnutrition 85
Session 9: Outpatient Therapeutic Care 91
Session 10: Community Mobilization 110
Session 11: Nutrition Care For PLHIV 118
Session 12: Common HIV/AIDS Therapies, Dietary Recommendations & Side Effects 131
Session 13: An Overview Of Standard Operating Procedures For Ordering, 151
Receiving, Storage & Distribution Of Rutf
Session 14: Monitoring And Reporting 160
Session 15: Implementation Plan & Process For Integrating Nutrition Into 174
HIV/AIDS & OVC Care & Support Services
Session 16: Basic Skills In Counselling & Health Education 185
Appendix 205
Nutrition Care for PLHIV Training Manual | i
Acronyms
ACDI/VOCA Agricultural Cooperative Development International and Volunteers in
Overseas Cooperative Assistance
AIDS Acquired Immune Defciency Syndrome
ART Antiretroviral Therapy
ARVs Antiretroviral Drugs
AZT Zidovudine
BMI Body Mass Index
BMR Basal Metabolic Rate
EIA Enzyme Immune Assay
ELISA Enzyme Linked Immunosorbent Assay
FANTA Food and Nutrition Technical Assistance
FAO Food and Agriculture Organization Of The United Nations
GIT Gastric Intestinal Tract
GMP Growth M Promotion
HAART Therapy Or Highly Active Antiretroviral Therapy
HE Health Education
HIV Human defciency Virus Responsible For Causing AIDS
IDV Indinavir
IMAM Integrated Management of Acute Malnutrition
IMCI Integrated Management of Child Illness
ITC Inpatient Therapeutic Care
IYCF Infant and Young Child Feeding
MAM Moderate Acute Malnutrition
MUAC Mid Upper Arm Circumference Measurements
NAADS National Agricultural Advisory Services
NNRTI Non-Nucleoside Reverse Transcriptase Inhibitor
NRTI Nucleoside/Nucleotide Reverse Transcriptase Inhibitor
NRU Nutrition Rehabilitation Unit
ii | Nutrition Care for PLHIV Training Manual
Acronyms
OIs Opportunistic Infections
OTC Outpatient Therapeutic Care
OVC Orphans & Vulnerable Children
PCR Polymerase Chain Reaction
PI Protease Inhibitor
PLHIV People Living with Human Immunodefciency Virus
PMTCT Prevention of Mother to Child Transmission of HIV
RCT Retroviral Care Therapy
RDA Recommended Daily Allowance
RUTF Ready-To-Use Therapeutic Food
SAM Severe Acute Malnutrition
SFP Supplementary Feeding Program
SMART Specifc, measurable, achievable, realistic and time-bound
TB Tuberculosis
UDHS Uganda Demographic Health Survey
UNAIDS United Nation Acquired Immunodefciency Disease Syndrome
UNICEF United Nations Children’s Fund
VCT Voluntary Counselling and Testing
W/H Weight for Height
WHO World Health Organization
Nutrition Care for PLHIV Training Manual | iii
Review Of Facilitation
Techiques
Ancient Chinese Proverb
“Go in search of Your People Love them, learn from them. Plan with them, serve them; Begin
with what they have; Build on what they know. But of the best leaders, When their task is
accomplished, Their work is done, the People all remark: ‘We have done it ourselves”

Lao Tzu
Principles Of Peasant Pedagogy
• Progressive
• Concrete:
• Practical
• Active
• Use of proverbs and images
• Repetition is necessary to become competent
• Based on humour and images
Conditions Of Learning
– An environment of active people
– A climate of respect
– A climate of acceptance
– An atmosphere of trust
– A climate of self-discovery
– A non-threatening climate
– A climate of openness
– An emphasis on the uniquely personal nature of learning
– A climate in which differences are thought to be good and desirable
– A climate which recognizes the right of individuals to make mistakes
– An atmosphere that tolerates ambiguity
– An emphasis on co-operative evaluation and self-evaluation
Interactive Techniques
• Illustrated lecture
• Small group activities
• Brainstorming
• Case study
• Role plays
• Activities in dyad or triad
• Structured exercise
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Advantages of using a board
• Available in most training venues;
• Doesn’t need an electrical supply;
• Easy to use and cheap;
• Can be used by both trainer and trainees;
• Excellent for brainstorming, problem solving, listing and other participatory
techniques.
Disadvantages in using the board
• The board cannot contain a big quantity of information;
• It requires time to write on;
• It can be diffcult to write on while talking to participants ;
• You need to have chalk or markers to write on it, and they can be lost or fnished;
• What is written is not permanent;
Tips for board utilization
• Keep the board clean
• Utilize chalk or markers in colours that contrast well with the board colour
• Use large letters in order to allow participants to read wherever they are in the room
• Prepare any complex drawings in advance
• Underline titles and key words
• Don’t talk when you are writing
• Don’t block the participants’ vision
• Plan enough time for participants to take notes from the board
Advantages for using a Flipchart
• Available in most of training venues
• Easy to move around
• Doesn’t need an electrical supply
• Several can be used at the same time
• Easy to use and cheap
• Can be used by both trainer and trainees
• Can be prepared in advance
• Excellent for brainstorming, problem solving, listing and other participatory
techniques
• The sheets can be taken out and stuck to the wall
Tips for the fip chart utilization
• Utilize markers with wide point
• Use large letters in order to allow participants to read wherever they are in the room
• Use markers with different colours to help organize the different sections
• Prepare any complex drawings in advance, Underline the titles and the key words
• Don’t talk when you are writing
• Don’t block the participants’ vision
• Utilize big bullets and numbering to help organize the text
• Use titles, boxes etc
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Tips for the fip chart utilization
• Leave enough space between writing
• Avoid putting a lot of information in the same page
• When the pages are prepared in advance, leave a blank page between each prepared
sheet so you have room to make notes or additional drawings after each prepared
sheet
• Use masking tape to stick the sheets on the walls so you and the participants can
refer back to the previous sheets
• To hide one part of the sheet, fold up the bottom part and stick it to the upper part
with masking tape
• Face the participants while you are presenting, not the fip chart
Tips for an effcient facilitation
Movements
• Take centre stage, do not get stuck in a corner or behind a desk
• Face the audience, do not face the board or screen when speaking
• Avoid talking while turning your back to participants
• Use eye contact with people in all sections of the audience
• Move around the room approach people to get their attention and response
• Avoid blocking the participants view- watch for craning necks
Tips for an effcient facilitation
Interaction
• Try to interact with all participants- use name as appropriate
• Ask the questions suggested in the text – ask different participants
• Allow time for participants to answer. Don’t give the answer too quickly: drop hints
• When a participant response is partially correct, the trainer should congratulate him
for the correct part and improve the incorrect part or reformulate it
• When a participant’s response is incorrect, the trainer should reformulate the
question in order to guide the participant to the correct answer, giving clues or
asking in a different way.
• When a participant is not willing to respond, the trainer should ask the question to
another participant.
Speech
• Slow, clear and loud enough for everyone to hear
• Natural and lively- vary the tone and the level of your voice
• Write diffcult and new word on the board- pronounce and explain them
Visual aids
• Have the required aids and equipment ready-check and arrange them before the
session
• Make sure that everyone can see clearly arrange the room so that they can point to
what you are talking about on the screen
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