AIDS and Behavior

, Volume 22, Issue 1, pp 212–223 | Cite as

A Cluster Randomised Trial to Determine the Efficacy of the “Feeding Buddies” Programme in Improving Exclusive Breastfeeding Rates Among HIV-Infected Women in Rural KwaZulu-Natal, South Africa

  • Penelope Reimers
  • Kiersten Israel-Ballard
  • Marlies Craig
  • Lenore Spies
  • Ibou Thior
  • Frank Tanser
  • Anna Coutsoudis
Original Paper


This cluster randomised trial in KwaZulu-Natal South Africa, evaluated the implementation of a Feeding Buddies (FB) programme to improve exclusive breastfeeding (EBF) amongst human immunodeficiency virus infected mothers. Eight clinics were randomly allocated to intervention and control arms respectively. Pregnant women attending the prevention of mother-to-child transmission program and intending to EBF were enrolled: control (n = 326), intervention (n = 299). Intervention mothers selected FBs to support them and they were trained together (four sessions). Interviews of mothers occurred prenatally and at post-natal visits (day 3, weeks 6, 14 and 22). Breastfeeding results were analysed (Stata) as interval-censored time-to-event data, with up to four time intervals per mother. EBF rates at the final interview were similar for control and intervention groups: 44.68% (105/235) and 42.75% (109/255) respectively (p = 0.67). In Cox regression analysis better EBF rates were observed in mothers who received the appropriate training (p = 0.036), had a community care giver visit (p = 0.044), while controlling for other factors. Implementation realities reduced the potential effectiveness of the FBs.


HIV/AIDS Prevention of mother -to- child transmission Exclusive breastfeeding Feeding buddy 


Este ensayo aleatorio llevado a cabo en KwaZulu-Natal, Sudáfrica, evaluó la implementación del programa Feeding Buddies (FB) para mejorar la lactancia materna exclusiva (LME) entre las madres infectadas por el virus de inmunodeficiencia humana (VIH). Se seleccionaron grupos de intervención y de control en ocho clínicas diferentes de manera aleatoria. Se registraron mujeres embarazadas que asistían al programa de prevención de transmisión materno-infantil y que querían LME: control (n = 326), intervención (n = 299). Las madres del grupo de intervención seleccionaron el programa FB para que les diera apoyo y capacitación (cuatro sesiones). Las entrevistas con las madres ocurrieron en visitas pre y postparto (día 3, semanas 6, 14 y 22). Los resultados de la lactancia fueron analizados (Stata) como datos tiempo hasta que ocurre un evento censurados por intervalos, con una cantidad de hasta cuatro intervalos por madre. Las tasas de LME al final de la entrevista fueron similares para los grupos de control y de intervención: 44.68% (105/235) y 42.75% (109/255) respectivamente (p = 0.67). En el análisis de regresión de Cox, se observaron mejores tasas de LME en madres que recibieron una capacitación adecuada (p = 0.036), recibieron ayuda del/de la cuidador/a de la comunidad (p = 0.044), al tiempo que controlaban otros factores. Las realidades de implementación redujeron el potencial de efectividad del programa FB.

Palabras clave

VIH/SIDA Prevención de la transmisión materno-infantil Lactancia materna exclusiva Programa feeding buddy 



The study was funded by National Institute of Health, (NIH. 1759-05946-SUB) and the Window of Opportunity was supported by a grant from BPD Billiton Sustainable Community Program. We acknowledge with appreciation the participation of the mothers and the buddies. We thank the Department of Nutrition, KwaZulu-Natal, the District Health Office in Uthungulu and all the local clinics in the area for their cooperation and participation.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Approval for the study was obtained by both the University of KwaZulu Natal’s Biomedical Research Ethics Committee (BE001/13) and the PATH Research Ethics Committee (HS721) and all procedures performed were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments. Approval was also obtained from local stakeholders, which included the Provincial Department of Health as well as the Manager of the Maternal and Child Health Program, KZN. Informed written consent was obtained from all participants.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Penelope Reimers
    • 1
  • Kiersten Israel-Ballard
    • 2
  • Marlies Craig
    • 1
  • Lenore Spies
    • 3
  • Ibou Thior
    • 4
  • Frank Tanser
    • 5
    • 6
    • 7
  • Anna Coutsoudis
    • 1
  1. 1.Department of Paediatrics & Child HealthUniversity of KwaZulu-NatalDurbanSouth Africa
  2. 2.PATHSeattleUSA
  3. 3.Integrated Nutrition Programme at KwaZulu-Natal Department of HealthPietermaritzburgSouth Africa
  4. 4.PATHWashingtonUSA
  5. 5.Africa Health Research InstituteUniversity of KwaZulu-NatalSomkheleSouth Africa
  6. 6.School of Nursing and Public HealthUniversity of KwaZulu-NatalDurbanSouth Africa
  7. 7.Centre for the AIDS Programme of Research in South Africa –CAPRISAUniversity of KwaZulu-NatalDurbanSouth Africa

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