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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 for Health Workers. Objectives. Appropriately assess and counsel patients on nutrition and HIV - PowerPoint PPT Presentation
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Session 7:Session 7:Integrating Nutrition Assessment, Integrating Nutrition Assessment, Counselling, and Education into HIV Counselling, and Education into HIV and AIDS Careand AIDS Care Nutrition Management with HIV and AIDS: Practical Tools for Health Workers
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 2
ObjectivesObjectives
• Appropriately assess and counsel patients on nutrition and HIV
• Identify ways to integrate nutrition into HIV and AIDS care
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 3
Nutrition at Each Stage of HIV: Nutrition at Each Stage of HIV: Stage 1Stage 1• Symptoms
• No other infections• Generalised fatigue
• Nutrition Considerations• Healthy eating and hydration (drink fluids)• Nutrition assessment and education
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 4
Nutrition at Each Stage of HIV: Nutrition at Each Stage of HIV: Stage 2Stage 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 5
Nutrition at Each Stage of HIV: Nutrition at Each Stage of HIV: Stage 3Stage 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 6
Nutrition at Each Stage of HIV: Nutrition at Each Stage of HIV: Stage 4Stage 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 7
Nutrition AssessmentNutrition Assessment
• Anthropometric• Biochemical• Clinical• Dietary• Environmental• Food Security
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 8
AnthropometricsAnthropometrics
• 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 9
Weight Loss CalculationWeight Loss Calculation
• Percent weight loss• UBW = Usual Body Weight• CBW = Current Body Weight• Formula:
% loss = UBW – CBW x 100 UBW
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 10
Mid Upper Arm CircumferenceMid Upper Arm Circumference
• Use measuring tape; measure in cm• Estimates muscle loss• If less than 23 cm, possible muscle
wasting intervene with nutrition counselling
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 11
Body Mass Index (BMI)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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 12
BMI Reference ChartBMI Reference Chart Underweight Normal Weight Overweight Obese
BMI (kg/m2) 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42
Height (cm.) Weight (kg.)
152 37 40 42 44 46 48 50 53 56 58 60 62 64 67 70 72 74 76 78 81 84 86 88 90 92 94 97
154 38 40 42 45 48 50 52 54 57 60 62 64 66 68 71 74 76 78 80 83 86 88 90 92 95 98 100
156 39 42 44 46 48 51 54 56 58 61 64 66 68 70 73 76 78 80 82 85 88 90 92 95 94 100 102
158 40 42 45 48 50 52 55 58 60 62 65 68 70 72 75 78 80 82 85 88 90 92 95 98 100 102 105
160 41 44 46 48 51 54 56 59 62 64 66 69 72 74 77 80 82 84 87 90 92 94 97 100 102 105 108
162 42 44 47 50 52 55 58 60 63 66 68 71 74 76 79 82 84 86 89 92 94 97 100 102 105 108 110
164 43 46 48 51 54 56 59 62 64 67 70 72 75 78 81 84 86 89 92 94 97 100 102 105 108 110 113
166 44 47 50 52 55 58 61 64 66 69 72 74 77 80 83 86 88 91 94 96 99 102 105 108 110 113 116
168 45 48 51 54 56 59 62 65 68 70 73 76 79 82 85 88 90 93 96 99 102 104 107 110 113 116 118
170 46 49 52 55 58 61 64 66 69 72 75 78 81 84 87 90 92 95 98 101 104 107 110 113 116 118 120
172 47 50 53 56 59 62 65 68 71 74 77 80 83 86 90 94 97 100 103 106 108 110 112 115 118 120 124
174 48 51 55 58 61 64 67 70 73 76 79 82 85 88 91 94 97 100 103 106 109 112 115 118 120 124 127
176 50 53 56 59 62 65 68 71 74 77 81 84 87 90 93 96 99 102 105 108 111 115 118 120 124 127 130
178 51 54 57 60 63 67 71 74 76 79 82 85 89 92 95 98 101 105 108 111 114 117 120 124 127 130 133
180 52 55 58 61 65 68 71 75 78 81 84 87 97 94 97 101 104 107 110 113 117 120 123 126 130 133 136
182 53 56 59 63 66 69 73 76 79 83 86 89 93 96 98 103 106 109 113 116 119 123 126 129 132 136 139
184 55 57 61 64 68 71 74 78 81 85 88 91 95 98 102 105 108 112 115 118 122 125 129 132 135 139 142
186 55 59 63 66 67 73 76 79 83 87 90 93 97 101 104 107 111 114 117 120 124 128 131 135 138 142 145
188 57 60 63 67 71 74 77 81 85 89 92 95 99 103 106 109 113 117 120 124 127 131 134 138 141 145 148
190 57 61 65 69 73 76 79 83 87 91 94 97 101 104 108 112 115 119 123 126 130 133 137 141 144 148 152
192 59 63 67 70 73 77 81 85 89 93 96 99 103 107 111 115 118 120 125 129 133 136 140 144 147 151 155
194 61 64 67 71 75 79 83 87 91 94 97 101 105 109 113 117 120 124 128 132 135 139 143 147 151 154 158
196 61 65 69 73 77 81 85 89 93 96 99 103 107 111 115 119 123 127 131 134 138 142 146 150 154 157 161
198 63 67 71 75 79 83 87 91 95 98 101 105 109 113 117 120 125 129 133 137 141 145 149 153 157 161 165
200 63 67 71 75 79 83 87 91 95 99 103 107 111 115 119 124 128 132 136 140 144 148 152 156 160 164 168
Adapted from: RCQHC/FANTA
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 13
BBiochemicaliochemical
• 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)
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 14
CClinicallinical
• 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 15
DietaryDietary
• 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)?
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 16
EnvironmentalEnvironmental
• 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 17
Food SecurityFood 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 18
Additional InformationAdditional 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)
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 19
Anthropometric Anthropometric Measurement and BMI Measurement and BMI Calculation PracticeCalculation Practice
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 20
Assessment Diagnosis Action Plan
Nutrition Assessment Weight, Height, BMI,
Record nutrition symptoms
Praise good eating behaviours. Encourage continued healthy eating and weight maintenance
Severe Malnutrition BMI <16kg/m2, weight loss > 10%, persistent diarrhoea, fever, with or without other
symptoms
Moderate Malnutrition BMI 16.5 – 18.5 kg/m2, weight
loss < 10%, mild symptoms
Well Nourished BMI > 19 kg/m2, no weight loss
or symptoms
Regular follow up
Consider hospitalization with enteral, parenteral or supplemental feedings, treat infections, rehydrate, and promote weight gain with high calorie foods.
Treat symptoms/infection and prevent further weight loss and infections with high energy, protein, vitamin and mineral foods.
Follow up in 1-2 months
Follow up in 1 month
Nutrition Assessment Action PlanNutrition Assessment Action Plan
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 21
Integration of Nutrition into HIV Integration of Nutrition into HIV and AIDS Careand AIDS Care• Begin at VCT services• Address food availability and access• Weight loss prevention can improve
survival
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
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First HIV VisitFirst 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 23
Follow-up VisitsFollow-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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 24
For Patients in the HospitalFor 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 25
Integration into ART ProgrammeIntegration 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 26
Integration into PMTCT and Integration into PMTCT and Ongoing Paediatric CareOngoing 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 27
Nutrition CounsellingNutrition 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 28
Making Suggestions, not Making Suggestions, not CommandsCommands• 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 …?
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 29
Making Suggestions, not Making Suggestions, not CommandsCommands• 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
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 30
Counselling Role PlayCounselling Role Play
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 31
Integration Case StudyIntegration Case Study
Session 7: Integrating Nutrition into HIV and AIDS CareNutrition Management with HIV and AIDS Training
Slide 32
Key PointsKey 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