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

在艾滋病毒母亲中推广纯母乳喂养：基于理论的方法

基本信息

批准号：
8466544
负责人：
emily tuthill
金额：
$ 4.22万
依托单位：
UNIVERSITY OF CONNECTICUT STORRS
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-24 至 2015-09-23
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8466544
关键词：
5 year old Accounting Acute Address Adoption African Behavior Behavioral Birth Breast Feeding Cattle Cessation of life Child Clinic Communicable Diseases Complex Counseling Data Development Effectiveness Effectiveness of Interventions Equilibrium Evaluation Exclusive Breastfeeding Experimental Designs Feeding Methods Focus Groups Goals Guidelines HIV HIV Seropositivity Health Health Personnel Health behavior change Human Milk Immunization Infant Infant Health Infection Intervention Intervention Studies Interview Knowledge Life Maternal Mortality Measures Milk Modeling Morbidity - disease rate Mothers Motivation Participant Phase Pregnancy Pregnant Women Prevalence Prevention Probability Public Health Publishing Randomized Recruitment Activity Research Resources Risk Risk Behaviors Site South Africa Techniques Testing Time Treatment Efficacy United Nations Update Vertical Disease Transmission Visit Water Woman World Health Organization antiretroviral therapy base design feeding follow-up gastrointestinal high risk improved informant innovation meetings mortality motivational enhancement therapy nutrition pregnant programs respiratory skills theories therapy development transmission process

项目摘要

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. PUBLIC HEALTH RELEVANCE: The proposed project will test an Information, Motivation, Behavioral Skill model-based pilot intervention informed by elicitation research, to promote exclusive breastfeeding (EBF) among mothers living with HIV in South Africa. EBF is the cornerstone to public health measures focused on child survival and improved overall infant health. This program of research provides a practical and innovative approach to increase the practice of EBF through an intervention that is integrated into existing prevention of mother-to-child-transmission of HIV programs that directly target specific IMB barriers facing HIV-positive mothers in South Africa.

描述（由申请人提供）：2010 年，全世界约有 370,000 名儿童因母婴传播（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 岁以下儿童死亡人数的 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。尽管 HIV 阳性母亲的母乳喂养存在 HIV 母婴传播的风险，但通过 EBF 和适当的抗逆转录病毒治疗，该风险从 42% 降至 2%。 EBF 与较低 MTCT 相关的机制尚不完全清楚，但据信可维持胃肠道屏障，而胃肠道屏障被认为是主要感染部位。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、提供最佳营养、同时保护婴儿免受腹泻和呼吸道疾病方面具有显着的多重益处。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，HIV + 母亲在婴儿生命的前 6 个月内进行 EBF。然而，尽管在艾滋病毒母婴传播预防项目中用于促进 EBF 的资源有所增加，但这仍然是一种罕见的做法。在南非，76% 的艾滋病病毒感染者母亲在 3 个月大时用母乳、牛奶和粥喂养婴儿，大约 25% 在婴儿出生后的头 3 天内喂水。本研究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，旨在通过有针对性的基于 IMB 模型的干预措施来改变流行的非 EBF 实践。 IMB 模型用于引出最显着的 IMB 障碍，这些障碍抑制艾滋病毒感染者母亲实践 EBF，并利用这些数据为基于 IMB 模型的干预措施的设计提供信息，以使用动机访谈技术增强影响 EBF 行为的 IMB 决定因素。将进行严格的评估，以评估干预措施对 EBF 相关信息、动机、行为技能决定因素和 6 周随访时的 EBF 实践的有效性。拟议的研究提供了一种创新且实用的方法，通过利用一个完善的、经过经验证明的模型来帮助消除艾滋病毒母婴传播，该模型已在南非成功实施，以消除其他类型的艾滋病毒危险行为。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。公共卫生相关性：拟议项目将测试基于信息、动机、行为技能模型的试点干预措施，该干预措施由启发研究提供信息，以促进南非艾滋病毒感染者的纯母乳喂养 (EBF)。 EBF 是关注儿童生存和改善婴儿整体健康的公共卫生措施的基石。该研究计划提供了一种实用且创新的方法，通过将干预措施纳入现有的预防艾滋病毒母婴传播计划中，以增加 EBF 的实践，该计划直接针对南非艾滋病毒阳性母亲面临的特定 IMB 障碍。