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Zambia[2004-Present] The United States Government (USG) has made HIV prevention and treatment, and care and support of people living with HIV (PLHIV) a priority in Zambia. In support, FANTA-2 provides technical assistance to integrate food and nutrition components into programs for malnourished PLHIV and orphans and vulnerable children (OVC) and to strengthen the capacity of health care providers and USG PEPFAR Partners in nutrition assessment, counseling and support (NACS) at HIV care and treatment sites. National Guidelines for Nutrition Care for PLHIV: FANTA worked with USAID/Zambia, the Ministry of Health (MOH), the National Food and Nutrition Commission (NFNC) and local partners to develop national Guidelines for Nutritional Care and Support of PLHIV in 2004. These guidelines define the actions that service providers must take to provide quality nutrition care and support to supplement national policies on prevention and treatment and strengthen and harmonize PLHIV care and support across organizations, programs and services. FANTA-2 worked with the NFNC to update Zambia Nutrition Guidelines for Care and Support of People Living with HIV and AIDS (2011) to be in line with current global and national guidance. Training in Nutrition and HIV: The MOH and NFNC, with assistance from the United Nations Children’s Fund (UNICEF), drafted a nutrition and HIV course and the accompanying Nutrition Care and Support for People Living With HIV Training Manual, with a facilitators guide and participant handouts, for health care providers in facilities supported by USG PEPFAR Partners. The course includes anthropometric assessment, nutrition counseling and education, entry and exit criteria for food supplementation, and guidance on referrals to services for PLHIV. FANTA-2 completed the manual with input from NFNC, USG PEPFAR Partners, UNICEF and the World Food Programme (WFP). FANTA-2 is also working with the NFNC to develop community training and counseling materials on nutrition and HIV, including guidelines for referring malnourished clients to clinical services. Nutrition Counseling Materials for PLHIV: Building on the success of counseling materials developed in Uganda and Rwanda, FANTA worked with USAID/Zambia, the NFNC and local partners in 2006 to develop flip charts and wall charts for use in community- and facility-based care. The materials help strengthen counseling of PLHIV and antiretroviral therapy (ART) clients on the importance of good nutrition, living positively, preventing and fighting illness through diet, and maternal and infant nutrition. FANTA-2 worked with the NFNC and partners to update Zambia Counseling Flipchart – Eating and Living Well with HIV and AIDS: Good Nutrition Makes a Difference (2011) with technical assistance from the AED Communication for Change (C-Change) Project. Food by Prescription (FBP) Program: At USAID/Zambia's request, FANTA helped lay the groundwork for a FBP program for clinically malnourished PLHIV, OVC and prevention of mother-to-child transmission of HIV (PMTCT) clients. FANTA assessed current nutrition and HIV services; collected and analyzed data on production and distribution of therapeutic and supplementary foods for PLHIV and OVC; and submitted a report on current HIV food programming opportunities, options for an initial FBP program and partner roles. Working with Catholic Relief Services (CRS)/SUCCESS, FANTA-2 helped select initial sites and appropriate specialized food products; designed protocols, training manuals and a monitoring and evaluation system; and reviewed client, food prescription and distribution, and reporting forms. FANTA-2 also drafted Guidelines for a Food by Prescription Program in Zambia in partnership with NFNC. Promising Practices in Nutrition, Food Security and HIV Programming: The Regional Centre for Quality of Health Care (RCQHC) in Uganda and FANTA reviewed nutrition, food security and HIV programs in Zambia, Kenya, Malawi, Tanzania and Uganda to identify and document promising practices to help understand what works, replicate successful approaches and incorporate lessons into programs. The findings are available in the 2008 report Nutrition, Food Security and HIV: A Compendium of Promising Practices. Emergency Nutrition Support: In response to high rates of severe acute malnutrition (SAM) among infants in Lusaka District, in 2008, FANTA-2 worked with Valid International/Zambia to train and mentor health care staff in inpatient management of SAM in three rehabilitation centers to relieve the patient load at the University Teaching Hospital Nutrition Rehabilitation Unit. Support for the Sub-Committee on Nutrition, Food and HIV/AIDS: This committee was established in 2007 as a forum for coordinating and guiding nutrition and HIV activities in Zambia under the National AIDS Council (NAC)’s Treatment, Care and Support Theme Group. FANTA-2 provides technical and limited financial support to facilitate sub-committee activities, such as coordinating plans to introduce nutrition and HIV in pre-service medical training and integrate nutrition and HIV indicators in the health management information system.
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