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%），分娩期间（10-20%）或产后母乳喂养期间（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在长达6个月的时间里完全母乳喂养，一旦替代喂养是可接受的、可行的、负担得起的、可持续的和安全的，就停止母乳喂养。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。当从婴儿饮食中取消母乳喂养时，满足营养充足是一个主要问题，因为传统的断奶饮食往往是不足的，即使包括母乳。

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 Meeting nutritional adequacy when breastfeeding is withdrawn from the infant diet is of major concern, since traditional weaning diets are often inadequate even when breast milk is included.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.