xaba: infant feeding buddies strategy - an integrated approach

7/28/2019 Xaba: Infant Feeding Buddies Strategy - An Integrated Approach

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GNH Conference

16th April 2013

Gugu XabaNational Project Manager

Infant Feeding buddies Strategy:

An Integrated Approach (research andimplementation)


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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.

Infant feeding at 6 mos. of age.

25.7% exclusively breastfed; 24% exclusively formula fed and 53% mix-fed

(South Africa; HSRC, 2008).

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


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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.

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Support forHIV+

Mothers

Home

FacilityCommunity


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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.

Concept builds on ARV/adherence buddy model.

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Mother chooses trusted person to serve asbuddy.

Buddy provides ranges of support for mother.

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.


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Window of Opportunity Project Scope

South Africa

uThungulu, KwaZulu-Natal

& Nkangala, Mpumalanga

John Taolo Gaetsewe,

Northern Cape & Sedibeng,

Gauteng

Mozambique

Boane, Maputo Province

4/16/2013Page 7

South Africa

John TaoloGaetsewe Sedibeng

uThungulu

Nkangala

Boane

Mozambique


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Defining the Window of Opportunity

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Antenatal

Period

Intrapartum

& Neonatal

Periods

InfancyEarly

Childhood

The First 1,000 Days

Maternal andneonatal survival

Infant and child

health

Chronic and non-

communicable

diseases

Emotional and

cognitive

development


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PATHs project approach

Strengthen local health anddevelopment systems andcommunity structures to provideintersectoral services responsive to

the actual needs of communities

Health anddevelopment

system

Improve the quality and range ofclinical and community-basedservices addressing the health anddevelopment needs of children aged0-2

Serviceproviders

Increase behaviors among caregiversthat positively impact the health and

development of children aged 0-2 inbeneficiary communities

Communities

Expand the knowledge base andfoster the widespread adoption ofproject lessons

Stakeholdersat all levels

Targets Objectives

Improved

health and

developme

nt of

children

aged 0-2 in

the

communities

Cross -cutting strategies

Partnershipforownership

Facilitatingintersectoral

collaboration

B

uildingcapacity

Expandin

gthecontinuumofcare

Generatingandusingd

ata

Project

Goal


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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 ofpromoting HIV-free infant survival in resource-limited settings.

Specific aims

To determine the effect of a feeding buddy on adherence to exclusivebreastfeeding.

To determine the effect of a feeding buddy on adherence to ARVprophylaxis or ART regimens.

To determine the effect of a feeding buddy on adherence to infant HIVtesting 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

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)

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Window of Opportunity:

Implementing Feeding Buddies

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Improve EBF

rates at

6 months

Feeding buddies supported for all mothers during ANC

Implementation


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NIH: Evaluating Feeding Buddies

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

Enroll HIV+ mothers and

buddies during ANC

Intervention

clusters

Improve adherence

to PMTCT

recommendations

Comparison

clusters

Enroll HIV+ mothers during

ANC


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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, aperson she has chosen to provide support to her duringpregnancy 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 FeedingBuddy intervention and support role of buddies

Engage health staff to work with mothers and buddiesthroughout 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 populationwithin the context of a comprehensive health project.

Planning study procedures and data collection to allowpending 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.

xaba: infant feeding buddies strategy - an integrated approach

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