Elements and Applications of the NACS Approach Serigne Diene,
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Transcript of Elements and Applications of the NACS Approach Serigne Diene,
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PEPFAR
Elements and Applications of the
NACS Approach
Serigne Diene, Senior Nutrition and HIV Advisor (FANTA/FHI360)
AIDS 2012 - Turning the Tide Together
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Presentation Outline• NACS elements• Country achievements • Challenges and lessons learned• Way forward
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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
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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
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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
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National Policy and Coordination
Technica
l Working Gro
up
Nutrition Fo
cal Point
National Nutri
tion and HIV Guidelines
02468
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Capacity Strengthening
Training Ma-terial
Training Job Aids SBCC0
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Implementation
QI/Coaching Monitoring and Evaluation
Plans to Scale up
Links to community
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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
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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
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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
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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
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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
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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
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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
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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
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THANK YOU