pacfic aetc 2003 asilomar faculty development conference nutrition guides and resources for training...

Pacfic AETC 2003 Asilomar Faculty Development Conference

Nutrition Guides and Resources Nutrition Guides and Resources for Training HIV/AIDS Providersfor Training HIV/AIDS Providers

Marcy Fenton MS RD Nutritionist, AIDS Project Los Angeles

Education Committee Co-Chair, HIV/AIDS Dietetic Practice Group, American Dietetic Association

[email protected]

Barbara Scott, MPH, RDAssociate Professor, University of Nevada

School of Medicine, AETC, Reno, NVEducation Committee Member, HIV/AIDS Dietetic Practice Group,

American Dietetic Association

[email protected]


Learning ObjectivesLearning Objectives

Recognize the benefits of incorporating training on nutrition into the AETC curricula

Become familiar with qualifications of HIV Nutrition Providers/Trainers

Know how to access excellent nutrition trainers and use HIV nutrition guidelines and resources in AETC training

Understand comprehensive range of topics for nutrition training curricula

Increase support for adding dietitians as targeted AETC trainees


Nutrition is Important to Nutrition is Important to Include in AETC Training Include in AETC Training

because…... because…...


Poor Nutrition Can...Poor Nutrition Can... Contribute to impaired immune response; Result in more rapid disease progression &

shortened survival; Contribute to increased frequency and severity of

infections; Result in fatigue, loss of appetite, sense of taste

and smell, and decreased quality of life; Increase utilization of health care resources; Decrease tolerance to therapy and lessen

medication efficacy; and Be prevented in many cases with frequent

monitoring and early individualized and persistent treatment.


Medical Nutrition Therapy can...Medical Nutrition Therapy can...

Optimize nutrition status, immunity and overall well being

Prevent the development of specific nutrient deficiencies

Prevent loss of weight and lean body mass Reduce risk for onset or complications of co-

morbidities (e.g., diabetes, cardiovascular, osteoporosis, kidney & liver diseases)

Maximize effectiveness of medical and pharmacological treatments

Minimize health care costs


Qualified HIV Nutrition Qualified HIV Nutrition Providers Can Provide Providers Can Provide AETC Training...AETC Training...


National Network of National Network of Dietitians:Dietitians:

Members of the HIV/AIDS Dietetic Practice Group of the American Dietetic Association www.hivaidsdpg.org

Many are also members of Association of Nutrition Services Agencies www.aidsnutrition.org

All are educated in nutrition sciences: 4 year degree + internship), Registered Dietitian (RD)

Most specialize in HIV/AIDS and love working with patients and teaching

http://www.aidsnutrition.org/











AETCs Can Help Train More AETCs Can Help Train More Qualified Nutrition ProvidersQualified Nutrition Providers


Training for New HIV Nutrition Training for New HIV Nutrition ProvidersProviders

Link with HIV/AIDS Dietetic Practice Group trainers to design, provide, and evaluate nutrition training

Train AETC targeted providers and Medical Team Members (Physician, Physician Assistant, Nurse Practitioner, Registered Nurse, Social Worker, Pharmacist, Dentist, Mental Health Counselor) to hire and support (ex: reasonable patient load: 250-500 clients/1 FTE) qualified nutrition providers for their clinics

Support ongoing training for HIV Nutritionists/Dietitians APLA 4-day “Nutrition in HIV Care Education & Training” 2/9-12/2004 ANSA annual meeting Updates: HIV medical, pharmacology, nutrition


Many Resources Are Available to Many Resources Are Available to Guide Guide

Nutrition Training…..Nutrition Training…..


Health Care and HIV: Nutritional Guide for Providers and Clients 2nd Ed. 2002. HRSA/HAB, http://www.aids-etc.org/aidsetc?page=et-30-20-01

265 page manual (PDF files) Guidance for health care providers Patient handouts Some sections in Spanish Algorithms for care References


Integrating Nutrition Therapy into Medical Management of Human Immunodeficiency Virus Clin Infect Dis vol 36 suppl 2 Apr 2003 http://www.journals.uchicago.edu/CID/journal/contents/v36nS2.html

Nutrition Guidelines for Agencies Providing Food to People Living with HIV Disease, 2nd Ed. AIDS Nutrition Services Alliance (ANSA, now called Association of Nutrition Services Agencies) www.aidsnutrition.org

http://www.journals.uchicago.edu/CID/journal/contents/v36nS2.html







Guidelines for Implementing HIV/AIDS Medical Nutrition Therapy Protocols, Los Angeles County Commission on HIV Health Services, 1999 http://www.numedx.com/readstory.phtml?story=v2n3feature

HIV/AIDS Adults Medical Nutrition Therapy Protocol (ADA, Medical Nutrition Therapy Across the Continuum of Care, 1998) www.aids-etc.org/aidsetc?page=et-30-20-01

HIV/AIDS Children/Adolescents Medical Nutrition Therapy Protocol (ADA, Medical Nutrition Therapy Across the Continuum of Care, 1998) www.aids-etc.org/aidsetc?page=et-30-20-01

http://www.numedx.com/readstory.phtml?story=v2n3feature







http://www.aids-etc.org/aidsetc?page=et-30-20-01









Position of the American Dietetic Association and Dietitians of Canada: Nutrition intervention in the care of persons with human immunodeficiency virus. J Am Diet Assoc 2000;100:708-717 http://www.eatright.org/Public/ GovernmentAffairs/92_adap0600.cfm

Hepatitis C: Nutrition Care, Canadian Guidelines for Health Care Providers Dietitians of Canada, 2003 http://www.dietitians.ca/resources/HepatitisC_Guidelines.htm

http://www.eatright.org/Public/GovernmentAffairs/92_adap0600.cfm








Anticipated resourcesAnticipated resources

HIV/AIDS Medical Nutrition Therapy Protocols (Adult and Children) revisions (ADA) are expected in October, 2003 www.eatright.org

HIV/AIDS Medical Nutrition Therapy Evidence-Based Guides (ADA) are under development







Suggestions for Nutrition Suggestions for Nutrition Training ContentTraining Content


Nutrition Education & Nutrition Education & Counseling for All PatientsCounseling for All Patients

Rights of clients: To have early & ongoing access to medical nutrition

therapy in a time & location convenient to where medical services are received

To have a provider of medical nutrition therapy who is a qualified, HIV-knowledgeable, and capable dietetics practitioner

To refuse medical nutrition therapy That the environment safeguards & maintains their

confidentiality

Guidelines for Implementing HIV/AIDS Medical Nutrition Therapy Protocols, Los Angeles County Commission on HIV Health Services, 1999 Guidelines (text) http://www.numedx.com/readstory.phtml?story=v2n3feature














Nutrition Education & Nutrition Education & Counseling for All PatientsCounseling for All Patients

Topic areas include: Food & water safety and sanitation Maintenance of weight and lean body mass;

normal growth in children How to select foods for a healthful balanced

diet Food sources of important nutrients Dietary and nutritional supplement use Anticipatory guidance and intervention in

difficult times: diarrhea, nausea, fatigue, weight loss, other problems.


Nutrition Education & Nutrition Education & Counseling for All PatientsCounseling for All PatientsTopic areas include (continued): Role of exercise Nutrition during pregnancy Access to infant formula and food as an alternative to

breast-feeding Role of nutrition in:

maintenance of immune function; maintenance of organ function; wound healing; medication or treatment efficacy; prevention/treatment of chronic disease


Nutrition Screen & Referral Nutrition Screen & Referral Criteria for AdultsCriteria for Adults

Screen every 6 months &/or at status change. Categories for automatic referral to a registered

dietitian: Diagnosis and nutrition assessment Physical changes and weight concerns Oral/GI symptoms Metabolic complications & other medical conditions Barriers to nutrition, living environment, functional status Behavioral concerns or unusual eating behaviors http://www.

hivaidsdpg.org/Data/QM/HIV Adult_Nutrition_Screen_Referral_Criteria_200207.pdf

www.aahivm.org

Nutrition is part of primary medical care

http://www.hivaidsdpg.org/Data/QM/HIV_Adult_Nutrition_Screen_Referral_Criteria_200207.pdf













PositionsPositions

….efforts to optimize nutritional status, including medical nutrition therapy and nutrition education, should be components of the total health care provided to people infected with human immunodeficiency virus.

J Am Diet Assoc. 2000;100:708-717 (Expires 2003) ADA and Dietitians or Canada Joint Position. www.eatright.org/Public/GovernmentAffairs/92_adap0600.cfm

Patients should be entered into a continuum of medical care and services, including social, psychosocial, and nutritional services, with the availability of professional referral and consultation.

Guidelines for the Use of Antiretroviral Agents in HIV-1 Infected Adults and Adolescents, July 14, 2003 www.aidsinfo.nih.gov/guidelines/adult/AA_071403.pdf


Access to Access to Medical Nutrition TherapyMedical Nutrition Therapy

Ryan White CARE Act Title I:

Supports food services• Home-delivered meals, food banks, nutritional supplements: The

provision of actual food, meals, or nutritional supplements. It does not include finances to purchase food or meals. The provision of essential household supplies such as hygiene items and household cleaning supplies should be included in this item.

Other Outpatient/Community-Based Primary Medical Care Services

• Provision of nutrition education and/or counseling provided by a licensed/registered dietitian outside of a primary care visit. Nutritional counseling provided by other than a licensed/registered dietitian should be provided under psychosocial support services.



Ryan White CARE Act (cont.) AIDS Drug Assistance Program (ADAP)

Some require nutrition-related documentation for growth hormone, other anabolic agents, not specifying counseling

Some pay for nutritional supplements Title II

Includes funds for primary and supportive services, which includes nutrition and meal/food and supplements.

Title III (Early Intervention Services) Nutritional services, considered a primary care service, must

be provided to all persons living with HIV/AIDS whether on site or at another facility either directly or through a formal referral mechanism.

Nutritional services include dietary/nutritional evaluation, nutritional supplements and nutrition education or counseling optimally provided by a licensed registered dietitian or nutritionist.



Medicare Diabetes, Renal (pre-renal) – 1999 legislation, coverage

started 2001 Centers for Medicare & Medicaid Services (CMS) report

due 6/03 to Congress re: Cardiovascular disease (HR1225 / S 632) May recommend expansion to HIV, cancer, osteoporosis,

others. If recommendation:

• Bill will be introduced & your support is needed• Possibly all conditions with physician Rx will be covered

American Dietetic Association with HIV/AIDS Dietetic Practice Group is educating Congress on unique nutritional needs of HIV disease



Medicaid Limited: Washington DC, Georgia, Some state Medicaid

home health waiver programs Some pay for nutritional supplements

Private, HMOs, VA Irregular, many to mostly not covered Blue Cross of Massachusetts since 1996 HIV/AIDS MNT

Protocol

Prisons Irregular - often lack individualized nutrition care

Hospitalizations Usually nutrition coverage


HIV Medications & NutritionHIV Medications & Nutrition Restrictions and challenges of taking medications:

Generally: education, reinforcement, support adherence Specifically: food, meal, fluids, timing & schedule, pill burden

Side effects management Diarrhea, nausea, anorexia, fatigue,

chewing/swallowing/dental, bloating, heartburn, change in taste/smells, fat maldistribution metabolic complications (insulin, glucose, lipids, bone), others

Advocate for: Clearer nutrition-medication educational materials

PHS standard of care guidelines, package inserts, in clinics Clinical research to refine PHS Guidelines for nutrition (NORA)

Taking with and without food, fluid, side effects management, nutrient and nutritional status including body composition


Need for Food ResourcesNeed for Food Resources Questions of quality, quantity and financial and physical

accessibility Food and Meal Providers

Association of Nutrition Services Agencies www.aidsnutrition.org Local ASO’s, ANSA members, meals-on-wheels, farmers markets Food Stamps, Women, Infants & Children Program, School Lunch Program,

School Breakfast Program, etc. www.usda.gov Collaborate with anti-hunger organizations

National:

Community Food Security Coalition www.foodsecurity.org Food Research & Action Center (FRAC) 202-986-2200 www.frac.org

Local













AdditionalAdditionalHIV Nutrition ResourcesHIV Nutrition Resources


AIDS Project Los Angeles, HIV Nutrition Education Program www.apla.org

HIV Resources www.hivresources.orgHIV Fitness Guidelines www.hivfitness.orgAssociation of Nutrition Services Agencies www.

aidsnutrition.comPositive Communication 4 issues @ $30/year www.

hivaidsdpg.orgTufts University Health & Nutrition Letter www.

healthletter.tufts.edu The Body www.thebody.comNumedx www.numedx.com




































Thank You for Your Thank You for Your Attention!Attention!

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