the evolution of the nutrition assessment , counseling & support (nacs) approach tim quick
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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. Slim disease: a new disease in Uganda and its association with HTLV-III infection - PowerPoint PPT PresentationTRANSCRIPT
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PEPFAR
The Evolution of the Nutrition Assessment, Counseling & Support
(NACS) ApproachTim Quick
USAID Office of HIV/AIDSCo-Chair, PEPFAR Food & Nutrition Technical Working Group
AIDS 2012 - Turning the Tide Together
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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
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Malnutrition:•Weakened immune system• Increased susceptibility to
opportunistic infections•Wasting & increased mortality • Poorer adherence & response
to treatment
HIV/AIDS:• Loss of appetite• Increased nutrient
requirements• Impaired nutrient absorption• Altered nutrient metabolism
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Nutrient requirements for people living with HIV/AIDS
Report of a Technical Consultation World Health OrganizationGeneva, 13–15 May 2003
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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.”
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Policy Guidance on the Use of Emergency Plan Funds to Address Food and Nutrition Needs
September 2006The 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.
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Kenya Foodby
Prescription Program
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Entry Points
Assessment
Counseling
Clinical Mgmt PMTCT/ART
Support
Community Surveillance,
Referral, Counseling &
Support
Clinic Community
NACS -- Linking Clinics & Communities
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• 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
Why NACS?
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Fortification
CMAM
Zinc supplementation
Growth
monitoring
&
promotion
Universal
salt
iodization
PD Hearth
Vitamin A
supplementation
Infant &Young child feeding
Iron/FA
supplementation
Maternal nutrition
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NACS
NACS
NACS
NACS
NACS
Nutrition Assessment, Counseling & Support
Establishing a Nutrition Standard of Care
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Standard of Nutrition Care
Continuum of Nutrition Care
Assessment Counseling Support
Infants & Young Children
Women in Pregnancy & Postpartum
Adults & Adolescents
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Entry Points
Assessment
Counseling
Clinical Mgmt
Support
Clinic
NACSHousehold Economic
Strengthening & Livelihood Support
Promotionvocational training, IGAs,
microcredit
Protectionhousehold food
production, savings
Provisionsocial grants, food
assistance
CBO
Household Assessment &
Service Referral
Service Mapping
Service Strengthening
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NACS: A Life Cycle Approach
Adul
thoo
d
Birth
Pregnancy
Infancy
ChildhoodAdolescence
NACS
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BirthPregnancy Infancy Childhood Adolescence Adulthood
Linearizing the Life Cycle as a Continuum of Care
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BirthPregnancy Infancy Childhood Adolescence Adulthood
C & TART & ARV Prophylaxis
Tx of Malnutrition
Maternal Nutrition &
IYCF Counseling
Photo: Wendy Hammond
Photos: Wendy Hammond
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BirthPregnancy Infancy Childhood Adolescence Adulthood
ART & ARV Prophylaxis
Peri-/Postnatal Care
Maternal Nutrition &
IYCF Counseling Photo: Wendy Hammond
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BirthPregnancy Infancy Childhood Adolescence Adulthood
Photos: Save the Children Federation
Postnatal CareDeworming
MicronutrientsIYCF/GMP
CMAMTracking/Follow-Up of
Mother-Infant Pairs
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BirthPregnancy Infancy Childhood Adolescence Adulthood
Photo of Plumpy’nut® from Valid International; all others: Save the Children Federation
Pediatric CareNutrition
Surveillance/GMP & Referral
MicronutrientsCMAM
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BirthPregnancy Infancy Childhood Adolescence Adulthood
Photo: LINKAGES Project
Nutrition Surveillance,
Referral, Assessment & CounselingDeworming
MicronutrientsCMAM
Nutrition Surveillance,
Referral, Assessment & Counseling
MicronutrientsTx of malnutrition
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Early ImplementationNigeria, DR Congo, Lesotho, Vietnam
Program ExpansionCôte d’Ivoire, Ghana, Ethiopia, Uganda, Tanzania, Mozambique Namibia, Zambia, South Africa, Haiti
Implementation at National ScaleMalawi and Kenya
Phased Implementation of NACS
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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
KenyaUganda TanzaniaMozambiqueSouth Africa Lesotho
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Enabling Environment
Policies, Strategies & Guidelines Training
Research/M&E/HIS
Supply Chain Management
Quality Improvement
Human Resources
Funding/Financing
Patient Referral & Tracking
Mapping/Strengthening
Referral Services
NACS
Community Demand