Number/percent of HIV care and treatment sites with at least one service provider trained in a ministry of health-approved course on nutrition and HIV

The number or proportion of HIV care and treatment sites in a country or specified area that have at least one staff member (e.g., nurse, counselor, nutritionist) who have been trained in a ministry of health-approved course to provide nutrition assessment, education and counseling (NAEC) services to persons living with HIV (PLHIV) (Fanta 2008).

This indicator is calculated as:

(Number of HIV care/treatment sites with at least one staff member trained in a MOH-approved course for NEAC services for PLHIV /Total number of HIV care/treatment sites in a country or specified area) x 100

Surveys or reports from program sites provided by supervisors or evaluators on the presence of (or number of) staff trained to provide NAEC services using a census-based approach (i.e., from all program sites in the target area). The data collector should ask the manager at each site if any staff members have attended a MOH-approved course on nutrition and HIV and establish a list of names with their professional positions. Next, the data collector should follow up individually with the listed service providers to confirm that the information is correct. If at least one service provider at the site is confirmed to have attended a MOH-approved training, the site is recorded as meeting the requirements of the indicator.  Where the data are available, the indicator can be disaggregated by province or district, urban/rural location, type of facility (public, private, community-based), and client characteristics (age group, sex, most-at-risk populations).

Surveys, reports, and interviews from program sites and staff trained in NEAC.

The availability of appropriately trained service providers helps ensure that NAEC is provided at HIV care and treatment sites, that staff perform NAEC appropriately and give clients comprehensive and correct information.  Given the growing recognition of the important role nutrition plays in the care and support of PLHIV and the scaling up NEAC services into HIV care and support programs, adequate training of providers and harmonized approaches to monitoring and evaluation specific for nutrition and HIV are essential.  This indicator can provide information on overall training coverage, distribution of trained providers, workload constraints, and future needs for training and funding. Additional background on NEAC, a conceptual framework, process for developing an M&E system, and related indicators can be found in FANTA (2008)

WHO has recommended that any comprehensive program for HIV/AIDS include nutritional support (WHO, 2003). Adequate nutrition helps maintain the immune system, sustain physical activity, and is essential for improving treatment outcomes with antiretroviral drugs. Women of reproductive age with HIV are a critical population for health and nutrition interventions. According to UNAIDS data from 2009, women account for over 50 percent of global HIV infections and over 19.2 million women live with HIV. The nutritional status of HIV-infected women before or during pregnancy and during lactation influences both the women’s health and the health and survival of their infants. An overview of the recommended nutrient requirements for people living with HIV (PLHIV) and specifically for pregnant and lactating women can be found at FANTA (2007).  For additional background and technical guidance on interventions and indicators for nutrition and HIV care and support and prevention of mother-to-child transmission of HIV, see WHO/UNICEF (2003); WHO (2004); UNAIDS (2010); and WHO/UNICEF/UNAIDS (2011)

Counting the number or presence of NEAC-trained staff alone does not capture knowledge or how well the staff are able to integrate the training with their professional roles.  Added indicators for quality of training, such as knowledge and follow-up on skills retention can be useful. Furthermore, it cannot be determined from this indicator if there is an adequate number of trained providers (in nutrition and HIV) for a particular site based on that site’s HIV care and treatment client load.

access, nutrition, training, HIV/AIDS, integration

FANTA (Food and Nutrition Technical Assistance) Project. 2007. Recommendation for the Nutrient Requirements for People Living with HIV/AIDS, Washington, DC: USAID/Academy for Educational Development.

FANTA (Food and Nutrition Technical Assistance) Project.  2008.  A Guide To Monitoring and Evaluation of Nutrition Assessment, Education and Counseling of People Living with HIV.  Washington, D.C.: USAID/Academy for Educational Development.

UNAIDS, 2010, Prevention of Mother-To-Child Transmission of HIV (PMTCT): Technical Guidance Note for Global Fund HIV Proposals, Geneva: UNAIDS.

WHO, 2003, Nutrient requirements for people living with HIV/AIDS: Report of a technical consultation, May 13-15, Geneva: WHO.

WHO, 2004, Nutrition Counseling, Care and Support for HIV-infected Women, Geneva, Switzerland: World Health Organization.

WHO/UNICEF, 2003, Global Strategy for Infant and Young Child Feeding, Geneva: WHO.

WHO/UNICEF/UNAIDS, 2011, A Guide on Indicators for Monitoring and Reporting on the Health Sector Response to HIV/AIDS. Geneva: WHO.