Exclusive breast-feeding promotion among HIV-infected women in South Africa: an Information–Motivation–Behavioural Skills model-based pilot intervention

• Published in: Public health nutrition Vol. 20; no. 8; pp. 1481 - 1490
• Main Authors: Tuthill, Emily L, Butler, Lisa M, Pellowski, Jennifer A, McGrath, Jacqueline M, Cusson, Regina M, Gable, Robert K, Fisher, Jeffrey D
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.06.2017
• Subjects: Addictive behaviors; Adult; Antiretroviral agents; Babies; Behavior; Breast; Breast Feeding; Breastfeeding & lactation; Clinical trials; Counseling; Design; Disease transmission; Drug therapy; Effectiveness; Evidence-based nursing; Feasibility Studies; Feeding; Feeding behavior; Female; Follow-Up Studies; Food; Health Behavior; health care workers; Health Education; health effects assessments; health services; HIV; HIV Infections; Human immunodeficiency virus; Humans; Immunization; Infants; Infectious Disease Transmission, Vertical - prevention & control; Intervention; Interventions; interviews; Mothers; Motivation; Nutrition; optimal nutrition; Pilot Projects; Postpartum; Public Health; Randomization; randomized clinical trials; Research Papers; Risk reduction; Rural Population; Sample Size; self-efficacy; Skills; Socioeconomic Factors; South Africa; Treatment Outcome; vertical disease transmission; women; Womens health; World Health Organization; Young Adult; South Africa; Information–Motivation–Behavioural Skills; South Africa; Mother-to-child transmission of HIV; Exclusive breast-feeding; HIV; Infant feeding
• ISSN: 1368-9800; 1475-2727; 1475-2727
• DOI: 10.1017/S1368980016003657

Exclusive breast-feeding (EBF) provides optimal nutrition for infants and mothers. The practice of EBF while adhering to antiretroviral medication decreases the risk of mother-to-child transmission of HIV from approximately 25 % to less than 5 %. Thus the WHO recommends EBF for the first 6 months among HIV-infected women living in resource-limited settings; however, EBF rates remain low. In the present study our aim was to design and implement a pilot intervention promoting EBF among HIV-infected women. The Information-Motivation-Behavioural Skills (IMB) model was applied in a brief motivational interviewing counselling session that was tested in a small randomized controlled trial. Pietermaritzburg, South Africa, at two comparable rural public health service clinics. Sixty-eight HIV-infected women in their third trimester were enrolled and completed baseline interviews between June and August 2014. Those randomized to the intervention arm received the IMB-based pilot intervention directly following baseline interviews. Follow-up interviews occurred at 6 weeks postpartum. While not significantly different between trial arms, high rates of intention and practice of EBF at 6-week follow-up were reported. Findings showed high levels of self-efficacy being significantly predictive of breast-feeding initiation and duration regardless of intervention arm. Future research must account for breast-feeding self-efficacy on sustaining breast-feeding behaviour and leverage strategies to enhance self-efficacy in supportive interventions. Supporting breast-feeding behaviour through programmes that include both individual-level and multi-systems components targeting the role of health-care providers, family and community may create environments that value and support EBF behaviour.