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Influences on Exclusive Breastfeeding Among Rural HIV-Infected South African Women: A Cluster Randomized Control Trial

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Abstract

South African guidelines for prevention-of-mother-to-child-transmission (PMTCT) of HIV emphasize exclusive breastfeeding (EBF). This study examined the impact of a PMTCT intervention and male involvement on EBF. In a two-phase cluster-randomized trial, rural South African community health centers were randomized to offer HIV-infected pregnant women PMTCT standard of care plus either: a behavioral PMTCT intervention, or a time-equivalent attention-control condition. Phase 1 women had non-participating male partners; Phase 2 women had participating partners. Pregnant women (n = 1398) were assessed on HIV stigma, disclosure of HIV status to partner, male involvement, and family planning knowledge. Feeding practices were assessed 6 weeks postpartum (56% retained). Reduced depressive symptomatology predicted EBF 6 weeks postpartum, adjusting for attrition (AOR = 0.954, p = 0.001). Neither male involvement in antenatal care, phase, HIV stigma, disclosure, nor family planning knowledge predicted EBF. Future studies and perinatal care should address depression, which has important implications for infant health.

Resumen

Las recomendaciones para la prevención de la transmisión maternoinfantil (PTMI) del VIH en Sudafrica enfatizan la lactancia materna exclusiva (LME). Este estudio examinó el impacto de una intervención de PTMI y la participación de parejas masculinas en la LME. En un ensayo aleatorizado por grupos de dos fases, centros de salud comunitarios rurales sudafricanos se asignaron al azar para ofrecer a las mujeres embarazadas infectadas por el VIH a un estándar de atención de PTMI más: 1) una intervención conductual de PTMI o 2) una condición de control equivalente al mismo tiempo. Las mujeres de la Fase 1 tenían parejas masculinas que no participaron en el estudio; las parejas de las mujeres en la Fase 2 participaron en el estudio. Las mujeres embarazadas (n = 1398) fueron evaluadas sobre el estigma del VIH, la revelación de su estado del VIH, el nivel participación de su pareja, y el conocimiento de planificación familiar. Las prácticas de alimentación se evaluaron 6 semanas (56%) después del parto. Menos depresión basal predijo LME 6 semanas posparto, ajustando por pérdidas durante el seguimiento (AOR = 0,954, p = 0,001). Ni la participacion masculina (AOR = 0,984, p = 0,614), la fase (AOR = 0,894, p = 0,514) ni otros factores predijeron la presencia de LME. Los estudios futuros y la atención perinatal deben tratar la depresión, ya que esto puede tener implicaciones importantes para la salud infantil.

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Funding

This study was funded by a Grant from NIH, R01HD078187 and with the support of the University of Miami Miller School of Medicine Center for AIDS Research, funded by an NIH Grant, P30AI073961.

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

    Deborah L. Jones, Violeta J. Rodriguez, Lissa N. Mandell & Stephen M. Weiss

  2. Department of Psychology, University of Georgia, Athens, GA, USA

    Violeta J. Rodriguez

  3. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

    Tae Kyoung Lee

  4. HIV/AIDS/STIs and TB (HAST) Research Programme, Human Sciences Research Council, Pretoria, South Africa

    Karl Peltzer

  5. Department of Research & Innovation, University of Limpopo, Sovenga, Polokwane, South Africa

    Karl Peltzer

  6. Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave., Suite 404A, Miami, FL, 33136, USA

    Deborah L. Jones

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  1. Deborah L. Jones
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  2. Violeta J. Rodriguez
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Correspondence to Deborah L. Jones.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Prior to study onset, ethical approval was obtained from the Mpumalanga Department of Health, the Human Sciences Research Council (HSRC) and the University of Miami (UM) Institutional Review Board. Ethical approval for the study was procured from the Human Sciences Research Council (HSRC) Research Ethics Committee (REC) (Number: REC4/21/08/13), the Department of Health and Welfare, Mpumalanga Provincial Government, and the University of Miami Miller School of Medicine Institutional Review Board (IRB ID: 20130238). The study was registered as a clinical trial on clinicaltrials.gov, Number NCT02085356.

Human and Animal Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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

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Jones, D.L., Rodriguez, V.J., Mandell, L.N. et al. Influences on Exclusive Breastfeeding Among Rural HIV-Infected South African Women: A Cluster Randomized Control Trial. AIDS Behav 22, 2966–2977 (2018). https://doi.org/10.1007/s10461-018-2197-z

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