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Improving Clinical Care
Medical Nutrition Therapy Now Required at Many Clinics

By Marcy Fenton, M.S., R.D.

June/July 2002

Improving Clinical Care: Medical Nutrition Therapy Now Required at Many Clinics

HIV medical nutrition therapy provided by a registered dietitian may be coming to your clinic.

County of Los Angeles Department of Health Services contracting with HIV/AIDS medical outpatient services using Ryan White CARE Act Title I funds now requires nutrition counseling. The contract calls for the providing of primary HIV medical care to incorporate ongoing nutrition counseling to clients and/or caregivers by a registered dietitian.

Los Angeles County is one of the first areas in the U.S. to realize this gain, which has long been needed. Twenty HIV/AIDS medical outpatient services providers in Los Angeles County are affected by this contract.

Some contracted medical outpatient service providers already employ a registered dietitian and provide nutrition services. Now all will be required.

The inclusion of nutrition in the contract is part of a larger effort by the Los Angeles County Department of Health Services to assure best care to all people with HIV in Los Angeles County. Last summer the Los Angeles County Commission of HIV Health Services adopted a Continuum of Care model. This model calls for including many important services in direct primary health services and requires that appropriate referrals be made and be available to a host of other types of needed care and services. The Office of AIDS Programs and Policy, the administrator for the county, is starting to implement the model with these contract changes.

Medical nutrition therapy visits should start one to six months after an HIV-positive diagnosis. The baseline visit includes nutrition assessment, and any necessary self-management training, nutrition education, recommendations and intervention. Assessment includes current and dietary history, height, weight history, and body composition and necessitates appropriate lab assessments. Referral for ongoing HIV medical nutrition therapy is triggered by time, a new or ongoing nutrition-related complication, or by the client's or caregiver's ability to understand and incorporate nutrition management skills. Adults with HIV should be seen by a registered dietitian at least twice a year.

Medical nutrition therapy supports adherence to HIV medications and assists in successful coordination of medication, meal and food requirements to increase drug effectiveness and decrease risk of developing resistance to medications. It helps monitor and reduce the risk of developing or managing insulin resistance and diabetes, and coronary-heart, liver and kidney diseases. Pregnant HIV-infected women require medical nutrition therapy to increase favorable outcomes for both mother and infant. Infants and children require medical nutrition therapy more often to monitor adequate intake for appropriate growth.

Clients have the right to have access to early and ongoing medical nutrition therapy, to be informed that it is available to them, and that it is available at a time and location that is convenient to when and where medical services are received without excessive cost. Clients have the right to medical nutrition therapy provided by a qualified, HIV-knowledgeable and capable registered dietitian, who is able to communicate in the client's language and with the client's medical team. Clients have the right to having their confidentiality protected and to decline medical nutrition therapy.

To assure the capability of the medical nutrition therapy provider, the Los Angeles County Commission on HIV Health Services' Guidelines for Implementing Medical Nutrition Therapy Protocols specify that this person must have more than only the basic qualifications to be a registered dietitian.

As the Guidelines state, "medical nutrition therapy directly contributes to the overall well being and can impact progression in those infected with HIV disease." No one wants an overlooked nutritional problem to cause unnecessary medical complications, whether serious, costly or simply inconvenient.

HIV/AIDS Medical Outpatient Service Providers in the Los Angeles Area

Marcy Fenton, M.S., R.D.Marcy Fenton, M.S., R.D., is a nutritionist at AIDS Project Los Angeles and can be reached at (213) 201-1611 or

Back to the June/July 2002 issue of Positive Living.

This article has been reprinted at The Body with the permission of AIDS Project Los Angeles (APLA).

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