The Feasibility of Replacement Feeding as an HIV Prevention Method in Malawi

描述（由申请人提供）：艾滋病毒的母婴传播（MTCT）可能发生在怀孕期间（5-10%），分娩（10-20%）或母乳喂养的产后时期（5-20%）。为了减少产后期间的母婴传播，世界卫生组织制定了艾滋病毒和婴儿喂养准则，其中建议选择母乳喂养的感染艾滋病毒的母亲进行长达6个月的纯母乳喂养，一旦替代喂养可接受、可行、负担得起、可持续和安全，则停止母乳喂养。使这些准则适应马拉维等资源贫乏地区低收入人口的当地情况是一项巨大的挑战。当母乳喂养从婴儿饮食中撤出时，满足营养充足性是一个主要问题，因为传统的断奶饮食即使包括母乳也往往不足。 母乳喂养、抗逆转录病毒和营养（BAN）研究是一项正在马拉维利隆圭进行的随机对照试验，旨在评估抗逆转录病毒和营养干预措施，以减少母乳喂养期间艾滋病毒的母婴传播。所有登记的母亲都被建议纯母乳喂养6个月，然后从6-7个月开始逐渐断奶。在6个月大时，向所有BAN母亲提供即食食疗食品，旨在提供婴儿所需的所有微量营养素，并取代母乳中提供的能量和蛋白质比例。利用正在进行的BAN研究的定量数据，我们将确定7-12个月婴儿饮食的整体营养充足性。我们将描述膳食组成，消费和充足的能量，蛋白质，脂肪和微量营养素的摄入量，喂养模式，并检查季节对饮食的影响。在退出BAN试验的BAN母亲和婴儿的子样本中，我们将探索喂养和护理实践、膳食充足性和生长，并将其与来自社区的母亲和婴儿的匹配样本进行比较。BAN研究提供了一个独特的机会，可以在提供高质量母乳替代品时评估母乳停止后的饮食模式，并在BAN儿童退出试验时探索喂养模式和生长。这一信息将有助于指导马拉维政府的政策和其他政策，以确定在提供纯母乳喂养咨询后为艾滋病毒阳性母亲提供高质量母乳替代品的可行性。 BAN研究提供了一个独特的机会，可以在提供高质量母乳替代品时评估母乳停止后的饮食模式，并在BAN儿童退出试验时探索喂养模式和生长。这一信息将有助于指导马拉维政府的政策和其他政策，以确定在完全母乳喂养咨询后为艾滋病毒阳性母亲提供高质量母乳替代品的可行性。

DESCRIPTION (provided by applicant): Mother-to-child-transmission (MTCT) of HIV can occur during pregnancy (5-10%), delivery (10-20%), or the postnatal period from breastfeeding (5-20%). For the purpose of reducing MTCT during the postnatal period, The World Health Organization has developed HIV and Infant feeding guidelines, which recommend exclusive breastfeeding for up to 6 months among HIV-infected mothers choosing to breastfeed, with cessation of breastfeeding once replacement feeding is acceptable, feasible, affordable, sustainable and safe. Adapting these guidelines to the local circumstances of low-income populations in resource poor settings, such as Malawi, is a great challenge. Meeting nutritional adequacy when breastfeeding is withdrawn from the infant diet is of major concern, since traditional weaning diets are often inadequate even when breast milk is included. The Breastfeeding, Antiretroviral, and Nutrition (BAN) study is an on-going, randomized controlled trial in Lilongwe, Malawi that is evaluating antiretroviral and nutrition interventions to reduce mother-to-child transmission of HIV during breastfeeding. All enrolled mothers are counseled to exclusively breastfeed for six months, and then to gradually wean their infants from 6-7 months. At 6 months, all BAN mothers are provided with a ready-to-use therapeutic food (RUTF), which is designed to provide all the infants' micronutrient requirements and to replace the proportion of energy and protein that would be provided in breastmilk. Using quantitative data from the on-going BAN Study, we will determine overall nutrient adequacy of the infant diet at 7-12 months. We will describe dietary composition, consumption and adequacy of energy, protein, fat and micronutrient intakes, feeding patterns, and examine the influence of season on diet. Among a sub-sample of BAN mothers and infants who have exited the BAN trial, we will explore feeding and care practices, dietary adequacy, and growth and compare these with a matched sample of mothers and infants from the community. The BAN study provides a unique opportunity to assess dietary patterns after breastmilk cessation when a high quality breastmilk substitute is provided, and to explore feeding patterns and growth when BAN children exit the trial. This information will help to guide the Malawi government policy and others on the feasibility of the provision of a high-quality breastmilk replacement for HIV positive mothers after exclusive breastfeeding counseling.PROPOSAL NARRATIVE The BAN study provides a unique opportunity to assess dietary patterns after breastmilk cessation when a high quality breastmilk substitute is provided, and to explore feeding patterns and growth when BAN children exit the trial. This information will help to guide the Malawi government policy and others on the feasibility of the provision of a high-quality breastmilk replacement for HIV positive mothers after exclusive breastfeeding counseling.