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Elements and Applications of the NACS Approach Serigne Diene, Senior Nutrition and HIV Advisor (FANTA/FHI360). Presentation Outline NACS elements Country achievements Challenges and lessons learned Way forward. Integrating Nutrition into National HIV Responses (1).

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Elements and applications of the nacs approach serigne diene


Elements and applications of the nacs approach serigne diene

Presentation Outline

  • NACS elements

  • Country achievements

  • Challenges and lessons learned

  • Way forward


Integrating nutrition into national hiv responses 1
Integrating Nutritioninto National HIV Responses (1)

  • National Policy and Coordination

    • National nutrition and HIV guidelines

    • National nutrition and HIV strategy

    • Nutrition incorporated into HIV policies and vice versa

    • Technical coordinating group

    • Nutrition focal point in National AIDS Control Program


Integrating nutrition into national hiv responses 2
Integrating Nutritioninto National HIV Responses (2)

  • Capacity Strengthening

    • In-service and pre-service training of health care providers (linking the two ?)

    • Job aids

    • SBCC materials

    • Anthropometric equipment

    • Mentoring and supervision

    • QA/QI

    • M&E


Integrating nutrition into national hiv responses 3
Integrating Nutritioninto National HIV Responses (3)

  • Service delivery

    • Nutrition assessment

    • Nutrition education and counseling

    • Specialized food products

    • Micronutrient supplementation

    • Water, sanitation, and hygiene (WASH)

    • Food security support





Challenges
Challenges

  • Food and nutrition needs of non-HIV-affected populations (ethical and practical considerations)

  • Overstretched health systems and service provider time constraints

  • Limited scale

  • Geographic overlap with broader food security services


Lessons 1
Lessons (1)

  • Health facilities a good entry point for PLHIV nutrition services, but need to integrate NACS into community services and establish two-way referral mechanisms between facility and community services

  • Importance of integration into existing systems (e.g., patient flow, information flow)

  • Importance of ownership by medical stakeholders


Lessons 2
Lessons (2)

  • Importance of human resource capacity in nutrition

  • Value of seconding nutrition focal point to government AIDS control program

  • Need to balance meeting HIV objectives and achieving nutrition-specific goals

  • Need for coordination and agreement on a cohesive nutrition approach

  • HIV care and treatment as opportunities to strengthen nutrition capacity and services


Way forward 1
Way forward (1)

  • Scale-up of NACS services

    • Site assessments

    • Tailoring service delivery to existing systems

    • Training

    • Materials

    • On-the-job mentoring

    • Coordination among partners

    • M&E

    • Cross-site learning


Way forward 2
Way forward (2)

  • Strengthening health system and human resource capacity

  • Integrating NACS into client flow as a routine standard of care

  • Including nutritional status as a criterion in care and treatment protocols

  • Incorporating nutrition information in client registers and health management information systems


Way forward 3
Way forward (3)

  • Nutrition care in community-based services and links to acute malnutrition services

  • Introducing basic nutrition services as part of home-based care and other community-based services

  • Establishing linkages between facility and community services for follow-up, referral, and complementary services


Way forward 4
Way forward (4)

  • Quality improvement (QI)

  • QI applied to nutrition care services as part of training, service delivery, and monitoring

  • Nutrition incorporated into existing QI systems used in HIV care and treatment

  • Learning sites and centers of excellence to demonstrate QI processes and results


Way forward 5
Way forward (5)

  • Enough experience to assess strengths and weaknesses of the NACS approach and critical conditions for effective implementation

  • Evaluation of the impact of nutrition counseling on key health outcomes

  • Evaluation of the of therapeutic and supplementary food in delaying need for initiation of ART

  • Evaluation of different delivery mechanisms