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

描述(申请人提供)：2010年，全世界约有37万名儿童因母婴传播而新感染艾滋病毒。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+母亲的母乳喂养存在艾滋病毒母婴传播的风险，但通过实施循证医学和适当的抗逆转录病毒治疗，这一风险从42%降至2%。EBF与低MTCT相关的机制尚不完全清楚，但据信维持胃肠道屏障，而胃肠道屏障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，同时保护他们免受腹泻和呼吸道疾病方面的多重好处是显著的。鉴于说明这些好处的压倒性证据，世界卫生组织在2010年更新了婴儿喂养指南，建议在资源有限的情况下，艾滋病毒+母亲在婴儿生命的前6个月进行EBF。然而，尽管在艾滋病毒母婴传播预防方案中增加了用于促进循证医学的资源，但它仍然是一种罕见的做法。在南非，76%的艾滋病毒携带者母亲在婴儿出生后3个月内用母乳、牛奶和粥的组合喂养婴儿，约25%的母亲在婴儿出生后的头3天内引入水。 以健康行为改变的信息、动机和行为技能(IMB)模型为理论和概念框架，本研究旨在通过有针对性的基于IMB模型的干预来改变流行的非循证医学实践。IMB模型被应用来引出最显著的IMB障碍，这些障碍阻碍了艾滋病毒携带者母亲实践EBF，并利用这些数据为基于IMB模型的干预设计提供信息，以利用激励访谈技术加强那些影响EBF行为的IMB决定因素。在6周的随访中，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实践的效果。这项拟议的研究提供了一种创新和实用的方法，通过利用已在南非成功实施的消除其他类型的艾滋病毒危险行为的成熟和经验证明的模式，帮助消除艾滋病毒的母婴传播。这一贡献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.