Guide to Screening for Food and Nutrition Services
Among Adolescents and Adults Living with HIV
Why Food and Nutrition Screening Matters
Food insecurity and poor nutrition are powerful determinants of HIV outcomes. For people living with HIV (PLWH), inadequate intake can accelerate disease progression, reduce the effectiveness of antiretroviral therapy (ART), increase the risk of opportunistic infections, and worsen mental health. Adolescents and adults alike experience these challenges, but the barriers they face often differ. Systematic screening helps clinicians identify those at risk early, connect them with appropriate services, and ultimately improve viral suppression rates and quality of life.
Key Concepts
- Food insecurity: Limited or uncertain access to nutritionally adequate food.
- Malnutrition: Deficiencies, excesses or imbalances in energy, protein or micronutrients.
- Nutrition support services: Food parcels, vouchers, supplemental nutrition programs, therapeutic feeding, nutrition counseling, and cash assistance.
- Screening tools: Brief, validated questionnaires that can be incorporated into routine visits.
StepbyStep Screening Process
1. Prepare the Clinical Setting
Train all staff on the purpose of screening and on maintaining a nonjudgmental environment.
Ensure privacy; screening should be done confidentially.
Have printed or electronic copies of the chosen tool available.
2. Choose an Appropriate Tool
Commonly used instruments include:
- Household Food Insecurity Access Scale (HFAAS): 9item questionnaire, adaptable for adolescents.
- Food Insecurity Experience Scale (FIES):** 8item, rapid and validated across many cultures.
- Nutrition Risk Screening (NRS2002) or MUST: For assessing malnutrition risk.
Pick the tool that aligns with your clinics workflow and the population you serve. For mixed adolescentadult settings, using both a foodinsecurity module and a malnutrition risk module is recommended.
3. Integrate Screening into the Visit
Add the questionnaire to the intake form or electronic medical record (EMR) template.
Ask the questions verbally if literacy is a concern.
Record responses immediately to avoid data loss.
4. Interpret Results
Scoring varies by tool. As a rule of thumb:
- Score 2 on HFAAS or FIES indicates moderatetosevere food insecurity.
- Malnutrition risk if BMI < 18.5, recent weight loss >5% or NRS2002 3.
Document the risk level and trigger the next step.
5. Provide Immediate Counseling
Regardless of severity, give brief nutrition education:
- Emphasize balanced meals, portion sizes, and safe food handling.
- Discuss how ART should be taken with food (or on an empty stomach) according to the regimen.
- Offer printed handouts in the clients preferred language.
6. Link to Food & Nutrition Services
Establish a referral pathway that includes:
- Government food assistance programs (e.g., SNAP, WIC, local food banks).
- NGO or communitybased nutrition programs.
- Therapeutic feeding clinics for severe malnutrition.
- Cash transfer schemes where available.
Assign a case manager or social worker to follow up within 2 weeks.
7. FollowUp and ReScreen
Rescreen every 36 months, or sooner if the clients clinical status changes.
Use the same tool to monitor trends and evaluate the impact of interventions.
Special Considerations for Adolescents
Adolescents have unique physiological and psychosocial needs:
- Growth spurts: Increased energy and micronutrient requirements.
- Stigma and disclosure: May avoid reporting food insecurity for fear of judgment.
- School meals: Reference school feeding programs when assessing access.
When screening adolescents, involve caregivers when appropriate, but maintain confidentiality for older teens.
Integrating Screening with HIV Care Continuum
Linking nutrition screening to each stage of HIV care maximizes impact:
- Testing & Diagnosis: Offer a brief foodsecurity question at the point of diagnosis.
- Linkage to Care: Introduce nutrition services during the first ART clinic visit.
- Retention & Adherence: Use nutrition counseling as a retention incentive; food parcels have been shown to improve appointment attendance.
- Viral Suppression Monitoring: Assess whether unresolved food insecurity correlates with missed doses.
Monitoring & Evaluation
Key indicators to track:
- Proportion of clients screened at each visit.
- Prevalence of moderatetosevere food insecurity.
- Number of referrals made and completed.
- Change in BMI or weight-for-age (for adolescents) over 6 months.
- Viral load suppression rates stratified by foodsecurity status.
Data can be captured in the EMR; periodic reports help advocate for resources.
Resources & References
Tools
- FAO Food Insecurity Experience Scale (FIES) fao.org
- World Health Organization WHO/UNICEF/WFP Guidelines on Measuring Malnutrition who.int
Programs
- USDA Food and Nutrition Service SNAP, WIC
- World Food Programme HIVspecific nutrition packages
- Local NGOs: list community food banks and nutrition assistance initiatives in your region.
TakeHome Messages
- Food insecurity and malnutrition directly affect HIV treatment outcomes.
- Screening is quick, lowcost, and can be embedded in any routine visit.
- Use validated tools (HFAAS, FIES, NRS2002) and act on the results immediately.
- Integrate nutrition counseling, referral, and followup into the HIV care continuum.
- Regular monitoring helps demonstrate impact and secures continued funding.
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