Exclusive Breastfeeding Promotion among HIV+ mothers: A theory-based approach

描述（由申请人提供）：2010年，全球约有37万儿童因母婴传播（MTCT）而新感染艾滋病毒。其中90%以上的感染发生在南非。艾滋病毒是南非孕产妇死亡的主要原因，占5岁以下儿童死亡的50%以上。 纯母乳喂养（EBF）已被确定为减少艾滋病毒母婴传播和改善婴儿健康的关键干预措施。虽然艾滋病毒阳性母亲的母乳喂养有母婴传播艾滋病毒的风险，但通过EBF和适当的抗逆转录病毒治疗，这一风险从42%降至2%。EBF与较低的MTCT相关的机制尚未完全了解，但据信可以维持胃肠道屏障，这被认为是感染的主要部位。与其他喂养方法相比，EBF在保护婴儿免受艾滋病毒母婴传播和提供最佳营养方面的多重益处是显着的，同时保护他们免受腹泻和呼吸道疾病。鉴于大量证据表明这些益处，世界卫生组织于2010年更新了婴儿喂养指南，建议在资源有限的环境中，艾滋病毒阳性母亲在婴儿出生后的前6个月进行EBF。然而，尽管在预防艾滋病毒母婴传播方案中增加了用于促进EBF的资源，但这仍然是一种罕见的做法。在南非，76%的艾滋病毒阳性母亲在婴儿3个月大时用母乳、牛奶和粥喂养婴儿，约25%的母亲在婴儿出生后的头3天内喂水。 使用信息，动机和行为技能（IMB）模型的健康行为改变的理论和概念框架，拟议的研究旨在改变流行的非EBF的做法，通过一个有针对性的IMB模型为基础的干预。IMB模型被应用于引出最突出的IMB障碍，抑制艾滋病毒感染的母亲从实践EBF和使用这些数据来告知设计的IMB模型为基础的干预措施，以提高那些IMB的决定因素影响EBF的行为，使用动机访谈技术。在6周随访时，将进行严格的评估，以评估干预对EBF相关信息、动机、行为技能决定因素和EBF实践的有效性。拟议的研究提供了一种创新和实用的方法，通过利用一种已成功实施以消除南非其他类型的艾滋病毒危险行为的成熟和经验证明的模型，帮助消除艾滋病毒的母婴传播。这是实现联合国大会特别会议确定的2011-2015年千年发展目标的关键一步。

DESCRIPTION (provided by applicant): In 2010 approximately 370,000 children were newly infected with HIV worldwide as a result of mother-to-child transmission (MTCT). Over 90% of these infections occurred in South Africa. HIV represents the main cause of maternal mortality in South Africa and accounts for over 50% of deaths in children under 5 years old. Exclusive breastfeeding (EBF) has been identified as a key intervention to reduce MTCT of HIV and improve infant health. Although breastfeeding by HIV+ mothers carries a risk of HIV transmission from mother-to-child, that risk decreases from 42% to 2% with the practice of EBF and appropriate antiretroviral therapy. The mechanism by which EBF is associated with lower MTCT is not fully understood, but believed to maintain the gastrointestinal barrier, which is thought to be the primary site of infection. The multiple benefits of EBF in protecting infants fro MTCT of HIV and providing optimal nutrition while protecting them against diarrheal and respiratory illness compared to other feeding methods are significant. Given the overwhelming evidence illustrating these benefits, in 2010 the World Health Organization updated their infant feeding guidelines to recommend in limited-resource settings HIV+ mothers engage in EBF for the first 6 months of their infant's life. However, despite increased resources devoted to promoting EBF within prevention of MTCT of HIV programs, it remains a rare practice. In South Africa, 76% of HIV+ mothers feed their infants a combination of breast milk, cow milk and porridge by 3 months, and approximately 25% introduce water within the first 3 days of the infant's life. Using the Information, Motivation, and Behavioral Skills (IMB) model of health behavior change as the theoretical and conceptual framework, the proposed study aims to change prevalent non-EBF practice through a well-targeted IMB-model based intervention. The IMB model is applied to elicit the most prominent IMB barriers inhibiting mothers living with HIV from practicing EBF and using this data to inform the design of an IMB-model based intervention to enhance those IMB determinants influencing EBF behavior using motivational interviewing techniques. Rigorous evaluation will occur to evaluate the efficacy of the intervention on EBF-relevant information, motivation, behavioral skills determinants, and EBF practice at 6 weeks follow-up. The proposed study contributes an innovative and practical approach to help eliminate MTCT of HIV through utilizing a well-established and empirically proven model that has been successfully implemented to eliminate other types of HIV risky behavior in South Africa. A contribution that constitutes a critical step in meeting the 2011-2015 Millennium Development Goals established by the United Nations General Assembly Special Session.