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NACS – The First Step to a Solution

This article explores the integration of nutrition into the care and treatment of people living with HIV/AIDS, and its impact on health outcomes and food security. It discusses key challenges and opportunities in implementing a comprehensive nutrition support program, including household assessment, counseling, economic strengthening, and food assistance. The article also highlights the importance of collaboration between clinics, communities, CBOs, and local governments in promoting better health, nutrition, and economic outcomes for vulnerable populations affected by HIV/AIDS.

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NACS – The First Step to a Solution

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  1. NACS – The First Step to a Solution Tim Quick USAID Senior Technical Advisor for HIV/AIDS & Nutrition PEPFAR Co-Chair, Food & Nutrition Technical Working Group

  2. HIV/AIDS: • Loss of appetite • Increased nutrient requirements • Impaired nutrient absorption • Altered nutrient metabolism • Malnutrition: • Weakened immune system • Increased susceptibility to opportunistic infections • Wasting & increased mortality • Poorer adherence & response to treatment

  3. HIV/AIDS: • Loss of productivity • Increased OVC and female- & child-headed households • Increased medical costs • Depletion of productive assets • Food Insecurity: • Increased high-risk sexual practices & HIV infection • Increased under- & malnutrition • Decreased adherence & retention in care & treatment

  4. WHO Consultation on Nutrition and HIV/AIDS in Africa: Evidence, Lessons and Recommendations for Action Durban, South Africa, 10–13 April 2005 … called 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.”

  5. Policy Guidance on the Use of Emergency Plan Funds to Address Food and Nutrition Needs September 2006 The 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.

  6. Kenya Food by Prescription Program

  7. Nutrition Assessment, Counseling & Support NACS = Clinical Management Community Surveillance, Referral, Counseling & Support Assessment Support Counseling Clinic Community

  8. Standard of Nutrition Care Assessment Counseling Support Continuum of Nutrition Care Infants & Young Children Women in Pregnancy & Postpartum Adults & Adolescents

  9. NACS Integrated Household Livelihood & Economic Strengthening Support CBO Clinical Mgmt Service Mapping Promotion vocational training, IGAs, microcredit Assessment Support Service Strengthening Protection household food production, savings Household Assessment & Service Referral Counseling Clinic Provision social grants, food assistance

  10. Phased Implementation of NACS Early Implementation Nigeria, DR Congo, Lesotho, Vietnam Program Expansion Côte d’Ivoire, Ghana, Ethiopia, Uganda, Tanzania, Mozambique Namibia, Zambia, South Africa, Haiti Implementation at National Scale Malawi and Kenya

  11. Why NACS? Links vulnerable to clinical services -- reciprocal impact between health & nutrition Corrective (MAM/SAM)  chronic nutrition management: Continuum of Care across the Life Cycle Clinics “anchor” nutrition support within communities Link patients to support groups & community nutrition & health services Referrals of patients & families to economic strengthening, livelihood & food security support Health system strengthening -- NACS is a HSS approach to integrate nutrition within health services for entire population, not just within HIV/AIDS programs

  12. Clinics & Communities as a Single Operational Unit NACS = Clinic Community

  13. Questions & Challenges for LIFT • Can we establish a system that provides ES/L/FS support through individual household assessment & referral to a range of provision, protection & promotion services within each community? • Does this case management ES/L/FS approach lead to better adherence and retention in health care, as well as improved food security and household resilience? • If clinics anchor NACS within the health system, what will give permanence to NACS ES/L/FS support within communities? • How do we foster, strengthen CBOs to assume the nexus role between the health system and ES/L/FS services? • Is there a role for local government in this system? • Are their specific ES/L/FS approaches that will recognize & capitalize on gender differences and lead to better health, nutrition, food security and economic outcomes for NACS families?

  14. Thank You!

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