Elements and Applications of the NACS Approach Serigne Diene,

1. Elements and Applications • of the • NACS Approach • Serigne Diene, • Senior Nutrition and HIV Advisor (FANTA/FHI360)

2. Presentation Outline • NACS elements • Country achievements • Challenges and lessons learned • Way forward

3. 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

4. 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

5. 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

6. National Policy and Coordination

7. Capacity Strengthening

8. Implementation

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. THANK YOU