Engaging family members to support breastfeeding and anti-retroviral therapy, prevent mother-to-child transmission of HIV

September 29, 2024

From UNC Institute for Global Health and Infectious Diseases

Children who are HIV-exposed and uninfected experience poor growth and development compared to children who are HIV-unexposed and uninfected. Exclusive breastfeeding with adherence to anti-retroviral therapy (ART) is a recommended practice for preventing mother-to-child transmission, but there are barriers to adherence.

Dr. Stephanie Martin

A pilot study led by Stephanie Martin, PhD, an assistant professor in the Department of Nutrition at the UNC Gillings School of Global Public Health sought to engage family members (who influence child care and feeding practices) and test counseling recommendations in order to improve care and feeding practices for children who are HIV-exposed but uninfected, along with increasing adherence to anti-retroviral therapy in women. The results of the study, published in AIDS and Behavior, show that families with children who are HIV-exposed and uninfected can benefit from focused support and tailored counseling.

Martin worked with mentors Benjamin Chi, MD, MSc, and Suzanne Maman, PhD, to design the study, which was conducted in Lusaka, Zambia, through UNC Project Zambia. Margaret Kasaro, MBChB, was the co-PI. Tulani Matenga (first author) led data collection in Lusaka as the study coordinator.

“We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors,” explained Martin, who received a development award from the Center for AIDS Research (CFAR) to fund the project. “And what we found is that there is a need for in-depth counseling for women living with HIV, and a need to engage male partners and other family members who can support recommended practices.”

The study enrolled postpartum women in Lusaka who were asked to identify a family member who could provide support at home. Then, in a series of visits, the researchers interviewed the women living with HIV about current practices. They also provided counseling on exclusive breastfeeding, responsive care and ART adherence. During the last visit, the women and their family members were interviewed about their experiences trying recommended practices, and interview transcripts were analyzed thematically.

Left Photo: Stephanie Martin (fourth from left) with former Gillings MPH students Harsh Agarwal (Global Health), Eni Johnson (Maternal, Child and Family Health), Melissa Lam-McCarthy (Nutrition), and Olu Adeniran (Health Policy Management). Right Photo: The Zambia-based team of co-authors worked with the UNC team throughout data collection and analysis. (Back row, left to right) Shimeo Sakanya, Rhoda Chabaputa, Josephine Nyambe, Laetitia Laetitia Mulenga and Douglas M. Habinda. (Front row, left to right) Tulani Francis L. Matenga and Sithembile Chanda.

“We used trials of improved practices, a participatory formative research methodology that engages participants and encourages them to try recommendations over time, and then share their experiences during follow-up interviews. This included counseling cards focused on learning through play and early communication, to promote early child development recommendations and optimal infant feeding.”

Researchers used counseling cards developed with USAID Advancing Nutrition to promote early child development recommendations and optimal infant feeding.

“Pregnant women living with HIV were less likely to express an intent to breastfeed (71% vs 99%). During the first 6 months postpartum, mothers living with HIV were also less likely to exclusively breastfeed compared to HIV-negative mothers. Mixed messages during infant feeding counseling, social and economic factors, and fear of HIV transmission influenced women’s choices to initiate and continue breastfeeding.”

The women reported several barriers to exclusive breastfeeding with the most common being fear of HIV transmission via breastfeeding—despite high ART adherence—and insufficient breastmilk. However, after counseling, they were less fearful of HIV transmission and improved breastfeeding practices. Both male partners and female family members appreciated being included in counseling and more involved in caregiving, and women living with HIV valued the increased support.

Martin says the next step will be to rigorously test the intervention components that were piloted with a larger sample.

“We need more evidence to determine that this intervention can improve care and feeding practices and women’s adherence, as well as reduce their fears around HIV transmission.”

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.