Infant Feeding buddies Strategy:

An Integrated Approach (research and implementation)

GNH Conference 16th April 2013 Gugu Xaba

National Project Manager

Background to the infant feeding buddies strategy

Scale-up of revised 2010 WHO PMTCT recommendations is needed and the South African Antiretroviral Treatment guidelines 2013 Cultural, social, and psychological factors influence the ability of women to follow PMTCT guidelines. Gaps in adherence exist across the PMTCT continuum.
25.7% exclusively breastfed; 24% exclusively formula fed and 53% mix-fed (South Africa; HSRC, 2008).

Infant feeding at 6 mos. of age.

Antiretrovirals.
Up to 40% of women found non-adherent to ARV prophylaxis (South Africa; Mepham, 2011).

Early infant diagnosis.

6-15% of HIV-exposed infants <1 year of age tested at 6 weeks (WHO, 2011).
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Background to the infant feeding buddies strategy

Mixed messages on breastfeeding Multiple Myths around health seeking behaviors Socio-Cultural dimensions Lack of strong community engagement on health improving interventions Lack of specific, methodological and consistent messaging which appeals to behavior change

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Home-based Support: Filling a Gap

Pressure from family and community impacts mothers sense of empowerment for healthy practices. Facility and community structures provide aspects of support. Ongoing, personalized support at the home-level is needed. Community
Support for HIV+ Mothers

Facility

Home
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Feeding Buddies: A Potential Source of Support

Pilot study in PATHs Khusela PMTCT Project, Eastern Cape, South Africa 2009.

Promising results suggest a best practice. Mother chooses trusted person to serve as buddy. Buddy provides ranges of support for mother.

Concept builds on ARV/adherence buddy model.

Evaluation needed to document impact.

Department of Health planning scale-up.

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Goal of Window of Opportunity

Improved health and development of children aged 02 years in selected communities.

Window of Opportunity Project Scope

Mozambique

South Africa

Nkangala John Taolo Gaetsewe Boane Sedibeng uThungulu

uThungulu, KwaZulu-Natal & Nkangala, Mpumalanga John Taolo Gaetsewe, Northern Cape & Sedibeng, Gauteng Boane, Maputo Province

Mozambique

South Africa

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Defining the Window of Opportunity

Maternal and neonatal survival

Antenatal Period

Intrapartum & Neonatal Periods

Infant and child health Infancy Early Childhood Emotional and cognitive development

The First 1,000 Days

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Chronic and noncommunicable diseases

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PATHs project approach

Targets Objectives Cross -cutting strategies
Expanding the continuum of care
Strengthen local health and development systems and Health and development community structures to provide intersectoral services responsive to system the actual needs of communities Improve the quality and range of clinical and community-based services addressing the health and development needs of children aged 0-2

Generating and using data

Service providers

Increase behaviors among caregivers that positively impact the health and Communities development of children aged 0-2 in beneficiary communities Stakeholders at all levels Expand the knowledge base and foster the widespread adoption of project lessons

health and developme nt of children aged 0-2 in the communitie s

Partnership for ownership

Project Goal Improved

Facilitating intersectoral collaboration

Building capacity

Evaluating the Impact of Feeding Buddies as a Window of Opportunity Project Activity

Implementation team
PATH Window of Opportunity Project Department of Health - uThungulu District, KwaZulu-Natal Province

Research and evaluation team

Department of Pediatrics and Child Health, University of KwaZulu-Natal PATH NIH investigators

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Infant feeding buddies project Goals and Aims

Goal
To evaluate the effect of a feeding buddy to support a mother to adhere to PMTCT recommendations, in order to establish feasible models of promoting HIV-free infant survival in resource-limited settings.

Specific aims
To determine the effect of a feeding buddy on adherence to exclusive breastfeeding. To determine the effect of a feeding buddy on adherence to ARV prophylaxis or ART regimens. To determine the effect of a feeding buddy on adherence to infant HIV testing at 6 weeks. To determine the effect of a feeding buddy on disclosure and stigma.

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Study Design
Location
uThungulu District, KwaZulu-Natal Province uMhlathuze and uMlalazi sub-Districts

Project status
IRB review Launch scheduled for June 2013

Cluster-randomized study

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Difference in proportion EBF at 5.5 months > 80% power 8:8 design Coefficient of variation of 0.25 20% loss to follow-up n=304/arm (38 women/cluster)

Window of Opportunity: Implementing Feeding Buddies

Implementation

Feeding buddies supported for all mothers during ANC

Improve EBF rates at 6 months

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NIH: Evaluating Feeding Buddies

Intervention clusters Comparison clusters

Enroll HIV+ mothers and buddies during ANC

Enroll HIV+ mothers during ANC

Data collected from participants at ANC, 3 days, 6 weeks and 22 weeks

Improve adherence to PMTCT recommendations

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Feeding Buddies Conceptual Model

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Feeding Buddy intervention

Through the Feeding Buddy intervention, PATH will: Support pregnant women selection of a buddy, a person she has chosen to provide support to her during pregnancy and in adhering to PMTCT recommendations Provide orientation and training to the buddy around care and support during pregnancy, postnatal period, exclusive breastfeeding and PMTCT Facilitate community-based participation in Feeding Buddy intervention and support role of buddies Engage health staff to work with mothers and buddies throughout pregnancy and postnatal period

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Bridging Research and Implementation: Preliminary Lessons Learned

Early and continued engagement with policy makers. Ensure alignment with national and provincial policies, priorities and needs. Embed PMTCT research aims into comprehensive and integrated maternal and child health programming. Alignment of program and research timelines. Designing evaluation to target HIV+ study population within the context of a comprehensive health project. Planning study procedures and data collection to allow pending shift in PMTCT ARV prophylaxis policy.
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Thank-you, Thank-you, Thank-you Siyabonga!!

Improved health and development of children aged 02 years in selected communities.