Table Of ContentREPUBLIC OF ZAMBIA
MINISTRY OF HEALTH
Nutriton Guidelines for
Care and Support of People
Living with HIV and AIDS
February 2011
Nutrition Guidelines
for Care and Support
of People Living with HIV and AIDS
For more copies and informaton, contact
Natonal Food and Nutriton Commission (NFNC)
P.O. Box 32669, Lusaka. Zambia
Email:
Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
Table of Contents
Table of Contents .............................................................................................. i
Foreword .......................................................................................................... i
Acknowledgements .......................................................................................... ii
Abbreviations and Acronyms ......................................................................... iii
Definitions ......................................................................................................... v
Chapter 1. Introduction .................................................................................... 1
1.1. Government Response to the HIV/AIDS Epidemic ............................... 3
1.2. Nutrition Guidelines for the Care and Support of People Living with
HIV and AIDS ....................................................................................... 4
Chapter 2. HIV/AIDS and Nutrition .................................................................. 6
2.1. Basic Nutrition ...................................................................................... 6
2.2. The Link between Nutrition and HIV ..................................................... 7
2.3. Nutritional Requirements of Adults with HIV or AIDS ......................... 10
2.4. Foods to Meet the Energy and Nutrient Needs of PLHIV ................... 12
2.5. Ensuring Adequate Nutrient and Energy Intake ................................. 15
Chapter 3. Nutrition Care and Support for Adult PLHIV .............................. 16
3.1. Nutrition Assessment of PLHIV .......................................................... 17
3.2. Nutrition Education and Counselling .................................................. 18
3.3. Nutrition Support ................................................................................ 20
3.4. Client Follow-Up and Referral ............................................................ 23
3.5. Nutrition Care and Support for PLHIV at Increased Risk of
Malnutrition ......................................................................................... 25
Chapter 4. Nutrition Care for HIV-Positive Pregnant and Post-
partum Women ............................................................................. 27
4.1. Nutritional Requirements of Pregnant and Post-partum Women
with and without HIV ........................................................................... 27
4.2. Nutrition Care for HIV-Positive Pregnant and Post-partum Women ... 30
Chapter 5. Nutrition Care for Infants and Young Children of HIV-
Positive Mothers .......................................................................... 31
5.1. Feeding Infants of HIV-Positive Mothers for the First 6 Months of
Life ..................................................................................................... 31
5.2. Nutrition Interventions for HIV-Infected Children over 6 Months Old .. 33
Chapter 6. Nutrition and Antiretroviral Therapy .......................................... 36
6.1. Drug-Food Interactions ....................................................................... 36
6.2. Herbal Treatments and Diet Supplements ......................................... 40
Chapter 7. Food and Water Safety and Hygiene .......................................... 41
7.1. Causes of Food- and Water-Borne Illness .......................................... 41
7.2. Food Safety ........................................................................................ 42
7.3. Water Safety ....................................................................................... 43
Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
Chapter 8. Food Security in Households with PLHIV .................................. 45
Chapter 9. Community Participation in Nutrition Care and Support
for PLHIV ....................................................................................... 47
Chapter 10. Data Collection and Management ............................................. 49
10.1. Purpose of Nutrition Data Collection .................................................. 49
10.2. Challenges in Nutrition and HIV Data Collection and Management ... 49
10.3. Nutrition and HIV Indicators ................................................................ 50
References ...................................................................................................... 53
Annex 1. Macronutrients and Micronutrients Needed for Good
Nutrition ........................................................................................ 56
Annex 2. Micronutrient Supplementation Recommendations for
Zambia .......................................................................................... 61
Annex 3. Nutritional Benefits of Zambian Foods ...................................... 62
Annex 4. Types of Nutrition Assessment for PLHIV ................................. 64
Annex 5. Counselling PLHIV to Maintain Desirable Weight ..................... 65
Annex 6. Dietary Management of HIV-Related Symptoms ....................... 67
Annex 7. Entry, Transition, and Exit Criteria for Specialised Food
Support for PLHIV ........................................................................ 70
Annex 8. Algorithm for Management of Acute Malnutrition in
Adults ............................................................................................ 73
Annex 9. Algorithm for Management of Acute Malnutrition in
Children ........................................................................................ 74
Annex 10. Food Recommendations for and Possible Side Effects of
Common HIV Medications Used in Zambia................................ 75
Annex 11. Counselling PLHIV on Nutrition and Antiretroviral Drugs ........ 80
Annex 12. Common Herbs and Spices ........................................................ 82
Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
Foreword
The Republic of Zambia has been hit hard by HIV and AIDS. The government
and its local and international partners have worked together the past 15 years
to reduce the spread of the epidemic and relieve the burden it has placed on
Zambian citizens, households, and the national economy.
Nutrition care is an important component of the treatment and care of people
living with HIV. These guidelines provide the information needed to optimise
such services. They were developed by a team led by the National Food and
Nutrition Commission for service providers at all levels and for people living with
HIV and their families.
The guidelines are subject to continual revision and updates. It is hoped that
any useful information that may Nationimprove the document will be
communicated to the National Food and Nutrition Commission or the Ministry of
Health and the National AIDS Commission.
The Honourable Kapembwa Simbao
Minister of Health
February 2011
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Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
Acknowledgements
The Ministry of Health, through the National Food and Nutrition Commission
(NFNC), appreciates the contributions made by various partners in the
development of these guidelines. The National HIV/AIDS/STI/TB Council
provided the policy and technical context. The United States Agency for
International Development (USAID)/Zambia contributed financial and technical
support. We also thank other stakeholders and development partners who
participated in the review and finalisation of this document.
Our sincere gratitude goes to our colleagues from the Network of Zambian
People Living with HIV/AIDS (NZP+) for their valuable input in ensuring that the
guidelines were tailored to the practical needs of people living with HIV and
AIDS in Zambia.
We are also grateful for the technical input from the Food and Nutrition
Technical Assistance II Project (FANTA-2), Infant and Young Child Nutrition
Project, the Catholic Relief Services (CRS) Scaling Up Community Care and
Enhancing Social Safety Nets Return to Life (SUCCESS/RTL) Project, the
Natural Resources Development College, the Ministry of Community
Development and Social Services, the Nutrition Association of Zambia,
UNICEF, the World Health Organisation (WHO), and the World Food
Programme (WFP), which provided a thorough technical review of the updated
guidelines.
Finally, we would like to acknowledge the tireless work of staff from NFNC in
compiling material and coordinating the process that led to the production of this
document.
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Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
Abbreviations and Acronyms
µg Microgram(s)
ABC Abacavir
AIDS Acquired immune deficiency syndrome
ART Antiretroviral therapy
ARV Antiretroviral drug
AUC Area under the plasma concentration-time curve
AZT Zidovudine
BFHI Baby-Friendly Hospital Initiative
BMI Body mass index
CDC U.S. Centers for Disease Control and Prevention
CIDRZ Centres for Infectious Disease Research in Zambia
cm Centimetre(s)
CMV Cytomegalovirus
CSO Central Statistical Office
dL Decilitre(s)
FAO Food and Agriculture Organization of the United Nations
FBF Fortified blended food
g Gram(s)
GMP Growth monitoring and promotion
HAART Highly active ART
Hb Haemoglobin
HBC Home-based care
HDL High-density lipoprotein
HEPS High-energy protein supplements
HIV Human immunodeficiency virus
IMAM Integrated Management of Acute Malnutrition
IU International unit
kcal Kilocalorie(s)
LDL Low-density lipoprotein
M&E Monitoring and evaluation
MAM Moderate acute malnutrition
mg Miligram(s)
MOH Ministry of Health
MTP Medium-Term Programme
MUAC Mid-upper arm circumference
n.d. No date
NAC National HIV/AIDS/STI/TB Council
NACS Nutrition assessment, counselling, and support for PLHIV
NASCOP Kenya National AIDS and STI Control Programme
NFNC National Food and Nutrition Commission
NGO Non-governmental organisation
NZP+ Network of Zambian People Living with HIV/AIDS
OVC Orphans and vulnerable children
PLHIV Person or people living with HIV
PMTCT Prevention of mother-to-child transmission of HIV
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Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
RDA Recommended dietary allowance
RUTF Ready-to-use therapeutic food
SAM Severe acute malnutrition
SD Standard deviation
STI Sexually transmitted infection
TB Tuberculosis
UL Uper limit
UNAIDS Joint United Nations Programme on HIV/AIDS
UNU United Nations University
WHO World Health Organisation
WFA Weight for age
WFH Weight for height
WFP World Food Programme
ZDHS Zambia Demographic and Health Survey
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Nutrition Guidelines for Care and Support of People Living with HIV and AIDS
Definitions
Advocacy Speaking or writing in support of someone
or something
AIDS A group of illnesses caused by HIV that
weaken the immune system
Antioxidant A substance (e.g., vitamin E, vitamin C,
zinc, selenium) that prevents and repairs
damage caused by free radicals (by-
products of the body’s use of oxygen)
Antiretroviral A drug used for HIV prophylaxis or
treatment but not cure
Balanced diet A diet containing foods which provide all
nutrients in the correct proportion for
adequate nourishment
Body mass index A statistical measure of the body based on
weight and height, calculated by dividing
weight in kilograms (kg) by height in metres
2
(m) squared, or (kg/m )
CD4 cells Specialised white blood cells which signal
to other cells in the immune system to
protect the body from bacteria or viruses.
HIV attacks these types of cells and uses
them to make more copies of HIV,
weakening the immune system and making
it unable to protect the body from illness
and infection
CD4 count The number of CD4 cells in a cubic millilitre
of blood
Complementary feeding Giving a child semi-solid or solid foods in
addition to breast milk from the sixth month
of life until the child is fully weaned
Enzyme A biological catalyst which enhances or
inhibits a chemical reaction
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