PEPFAR

Elements and Applications of the

NACS Approach

Serigne Diene, Senior Nutrition and HIV Advisor (FANTA/FHI360)

AIDS 2012 - Turning the Tide Together

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

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 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 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

National Policy and Coordination

Technica

l Working Gro

up

Nutrition Fo

cal Point

National Nutri

tion and HIV Guidelines

02468

1012

Num

ber o

f Cou

ntrie

s

Capacity Strengthening

Training Ma-terial

Training Job Aids SBCC0

2

4

6

8

10

12

Num

ber o

f Cou

ntrie

s

Implementation

QI/Coaching Monitoring and Evaluation

Plans to Scale up

Links to community

0

2

4

6

8

10

12

Num

ber o

f Cou

ntrie

s

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)

• 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)

• 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)

• 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)• 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)

– 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)

– 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)

– 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

THANK YOU