Adapting and using the manual

ADAPTING THE MANUAL FOR LOCAL USE

Although the recommendations in this manual are generic, the general principles will be relevant for most people living with HIV/AIDS. However, specific nutrition recommendations should be adapted to the needs of individuals and the local community.

In developing these recommendations, research findings and experience gained in a wide range of settings have been incorporated. Nevertheless, many of the countries and organizations using this manual will have their own experience and knowledge on caring for people living with HIV/AIDS. It is important that this local knowledge and experience be incorporated in the recommendations of the manual.

Adapting it for local use provides an opportunity for local organizations to participate, creating a sense of ownership whereby they are more likely to use the manual.

Adaptation may need to take place at different levels. Countries and/or organizations may wish to develop the manual for national use or make further adaptations to meet regional and more local levels.

CHANGES NEEDED

The changes needed to adapt the manual to the requirements of a particular country or region will involve:

Changes in foods and recipes to suit the local availability of food and community tastes and preferences in country, regional, urban or rural settings. This may mean omitting some foods from the manual and adding others of equivalent nutritional value.
Inclusion of recipes for local dishes, including locally available foods, ensuring that the recipes are compatible with healthy eating guidelines. Suggestions may be made to combine foods with local dishes to ensure a balanced meal. Recipes or cooking methods may be adapted to suit specific HIV-related complications (see Annex 1 for recipes).
Adaptation of recommendations to local realities, e.g. types of protected water systems, availability of refrigerators, local cooking procedures and measures of weight and volume.
Selection of those parts of the manual that are relevant to the local situation, e.g. nutritional problems, the pattern of symptoms, availability of treatments used for HIV/AIDS management, drug treatments and local priorities for the care of people with HIV/AIDS.
Modifications to include experiences gained locally in the nutritional support of people with HIV/AIDS.
Adaptation to the educational level and cultural background of the users. The adapted manual can be tested on local users to ascertain whether the words and pictures are understood and acceptable. Any words and pictures that are poorly understood should be replaced and the final versions tested again.

SOME SUGGESTIONS ON HOW TO ADAPT THE MANUAL

The manual can be adapted in different ways depending on its intended use and the resources and people available. One approach would be to form a technical working group of people (“stakeholders”) from key government positions and non-governmental organizations (NGOs) to promote nutrition for people with HIV/AIDS. This working group could meet on a regular basis, review the manual, make suggestions for content and then produce the local version. Suggestions for the role of this working group are given in the box.

Another approach would be to start with a workshop at the national level that would seek to involve all the main stakeholders, such as health and extension workers and other service providers, experts on HIV/AIDS and nutrition, organizations working with people living with HIV/AIDS and people living with HIV/AIDS themselves. The objectives of the workshop would be to identify the kind of manual required and develop a workplan and a budget for producing a locally relevant version. From this participatory process would emerge a technical working group to carry out the detailed work of implementing the recommendations and producing the revised manual. A suggested checklist for a workshop is given below.

Role of a technical working group

Plan how to mobilize resources and initiate the necessary steps.
Identify and review existing nutrition education and home-based care materials/services. As nutritional advice for people living with HIV/AIDS is no different from general nutritional advice in principle, some existing material can be used for the development of the guidelines.
Identify information gaps in existing material and additional information needed; develop an information collection strategy and define responsibilities.
Identify what needs to be developed.
Identify resource materials, including existing generic guidelines and the parts that can be adapted.
Put together recipes for food, herbal drinks and home cures and test them on volunteers for acceptability.
Seek local experience on nutrition and AIDS, identify additional recipes and assess them for suitability for inclusion in the manual.
Draft the guidelines (by drafting committee).
Share the guidelines with all stakeholders for comments.
Incorporate the comments.
Pre-test guidelines on local field staff to check that they are easy to read, clear and acceptable.
Finalize nutritional guidelines.

Suggested checklist for a national workshop

Hold a workshop with all stakeholders to:

build a common vision on content of the guidelines, the kind of materials
required and target groups;
refine and agree on the process of the development of the guidelines;
form a technical working group to work on the guidelines;
develop a workplan and a budget for the production of national guidelines on nutritional care and support for people living with HIV/AIDS;
mobilize resources.

DISSEMINATION OF THE GUIDELINES

Once the guidelines have been finalized, a programme for dissemination at national, district and local levels needs to be developed. This programme would include:

distribution of the guidelines to government, international and national organizations;
training workshops for field staff on the use of the guidelines in nutrition work with people with HIV/AIDS;
development of educational aids such as brochures, posters, leaflets, fact sheets, radio programmes, TV spots, training materials, issue briefs, music and theatre activities and nutrition ambassadors.

MONITORING AND EVALUATION

It is important to monitor the implementation of the guidelines and review them in the light of local experience. This could involve:

monitoring the number of people trained and the number of copies of guidelines distributed;
a follow-up meeting with key persons in agencies involved in the development of the local guidelines to assess the experience within their agency of the use of the manual;
follow-up and assessment of the use made of the manual, problems experienced and lessons learned by relevant field staff;
inviting comments from self-help groups on the guidelines;
interviews with people living with HIV/AIDS who have received nutrition education as part of the programme to assess the extent to which they have been able to follow the guidelines and suggest modifications.