The following are guidelines for health workers that can help promote effective nutrition- medication management for ART.
1. Counsel on:
• Understanding that ARVs are not a cure.
• Food effects on the medications’ efficacy, medication effects on nutrient absorption and metabolism, and the side effects of the medications.
• The timing for taking medications and food/meals. Explain the necessity of accurate timing for meals and drugs. Involve PLHA and family members in constructing a meal and drug-taking timetable and in selecting the foods available to address the negative effects of medications and food interactions.
• The dietary management of the medications’ negative effects on nutrient absorption, metabolism, distribution, and excretion and the side effects of the medications. Highlight the foods that should not be taken while taking the medications and provide appropriate guidance.
2. Provide psychosocial support at the onset of treatment.
3. Assess any difficulties that PLHA may be having in following the planned diet and timetable due to food access or availability, taste, or other reasons and whether there have been positive or negative changes in symptoms, side effects, or drug adherence. Consult with PLHA and suggest other options when recommended foods are not available.
Assessments help identify the most effective communications channels for disseminating the updated recommendations on dietary management of food and medication interactions to program planners, health workers, caregivers, and PLHA. Below are a series of questions that can guide health workers in carrying out an assessment:
• What ARVs and other medications are used?
• What are the specific ARV and medication-food interactions in the local context?
• What are the common side effects of these ARVs and medications? What known foods aggravate or alleviate the symptoms? What are the dietary responses?
• What medications, including modern and traditional, are taken for the treatment of opportunistic infections and the diseases common to the area? What are the drug-drug interactions? What are the drug-food interactions?
• What are the nutritional implications and the food recommendations to manage the side effects (e.g., nausea, loss of taste, poor nutrient absorption)? What is the effect of the medication on nutrient?
• What are the most effective communications channels to keep PLHA, caregivers, counsellors, and program managers informed about ARVs and other medications and their implications for nutrition.