xaba: infant feeding buddies strategy - an integrated approach
TRANSCRIPT
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GNH Conference
16th April 2013
Gugu XabaNational Project Manager
Infant Feeding buddies Strategy:
An Integrated Approach (research andimplementation)
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Background to the infant feeding buddies strategy
Scale-up of revised 2010 WHO PMTCT recommendations
is needed and the South African Antiretroviral Treatment guidelines
2013
Cultural, social, and psychological factors influence the ability
of women to follow PMTCT guidelines.
Gaps in adherence exist across the PMTCT continuum.
Infant feeding at 6 mos. of age.
25.7% exclusively breastfed; 24% exclusively formula fed and 53% mix-fed
(South Africa; HSRC, 2008).
Antiretrovirals.
Up to 40% of women found non-adherent to ARV prophylaxis
(South Africa; Mepham, 2011).
Early infant diagnosis.
6-15% of HIV-exposed infants
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Background to the infant feeding buddies strategy
Mixed messages on breastfeeding
Multiple Myths around health seeking behaviors
Socio-Cultural dimensions
Lack of strong community engagement on health
improving interventions
Lack of specific, methodological and consistent
messaging which appeals to behavior change
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Home-based Support: Filling a Gap
Pressure from family and community impacts mothers sense of
empowerment for healthy practices.
Facility and community structures provide aspects of support.
Ongoing, personalized support at the home-level is needed.
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Support forHIV+
Mothers
Home
FacilityCommunity
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Feeding Buddies: A Potential Source of Support
Pilot study in PATHs Khusela PMTCT Project,Eastern Cape, South Africa 2009.
Promising results suggest a best practice.
Concept builds on ARV/adherence buddy model.
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Mother chooses trusted person to serve asbuddy.
Buddy provides ranges of support for mother.
Evaluation needed to document impact.
Department of Health planning scale-up.
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Goal of Window of Opportunity
Improved health and development of children aged
02 years in selected communities.
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Window of Opportunity Project Scope
South Africa
uThungulu, KwaZulu-Natal
& Nkangala, Mpumalanga
John Taolo Gaetsewe,
Northern Cape & Sedibeng,
Gauteng
Mozambique
Boane, Maputo Province
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South Africa
John TaoloGaetsewe Sedibeng
uThungulu
Nkangala
Boane
Mozambique
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Defining the Window of Opportunity
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Antenatal
Period
Intrapartum
& Neonatal
Periods
InfancyEarly
Childhood
The First 1,000 Days
Maternal andneonatal survival
Infant and child
health
Chronic and non-
communicable
diseases
Emotional and
cognitive
development
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PATHs project approach
Strengthen local health anddevelopment systems andcommunity structures to provideintersectoral services responsive to
the actual needs of communities
Health anddevelopment
system
Improve the quality and range ofclinical and community-basedservices addressing the health anddevelopment needs of children aged0-2
Serviceproviders
Increase behaviors among caregiversthat positively impact the health and
development of children aged 0-2 inbeneficiary communities
Communities
Expand the knowledge base andfoster the widespread adoption ofproject lessons
Stakeholdersat all levels
Targets Objectives
Improved
health and
developme
nt of
children
aged 0-2 in
the
communities
Cross -cutting strategies
Partnershipforownership
Facilitatingintersectoral
collaboration
B
uildingcapacity
Expandin
gthecontinuumofcare
Generatingandusingd
ata
Project
Goal
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Evaluating the Impact of Feeding Buddies as a
Window of Opportunity Project Activity
Implementation team
PATH Window of Opportunity Project
Department of Health - uThungulu District,KwaZulu-Natal Province
Research and evaluation team
Department of Pediatrics and Child Health,University of KwaZulu-Natal
PATH NIH investigators
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Infant feeding buddies project Goals and Aims
Goal To evaluate the effect of a feeding buddy to support a mother to adhere
to PMTCT recommendations, in order to establish feasible models ofpromoting HIV-free infant survival in resource-limited settings.
Specific aims
To determine the effect of a feeding buddy on adherence to exclusivebreastfeeding.
To determine the effect of a feeding buddy on adherence to ARVprophylaxis or ART regimens.
To determine the effect of a feeding buddy on adherence to infant HIVtesting at 6 weeks.
To determine the effect of a feeding buddy on disclosure and stigma.
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Study Design
Location uThungulu District, KwaZulu-Natal Province
uMhlathuze and uMlalazi sub-Districts
Project status
IRB review Launch scheduled for June 2013
Cluster-randomized study
Difference in proportion EBF at 5.5 months
> 80% power 8:8 design
Coefficient of variation of 0.25
20% loss to follow-up
n=304/arm (38 women/cluster)
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Window of Opportunity:
Implementing Feeding Buddies
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Improve EBF
rates at
6 months
Feeding buddies supported for all mothers during ANC
Implementation
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NIH: Evaluating Feeding Buddies
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Data collected from participants at ANC, 3 days, 6 weeks and 22 weeks
Enroll HIV+ mothers and
buddies during ANC
Intervention
clusters
Improve adherence
to PMTCT
recommendations
Comparison
clusters
Enroll HIV+ mothers during
ANC
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Feeding Buddies Conceptual Model
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Feeding Buddy intervention
Through the Feeding Buddy intervention, PATH will:
Support pregnant women selection of a buddy, aperson she has chosen to provide support to her duringpregnancy and in adhering to PMTCT recommendations
Provide orientation and training to the buddy around
care and support during pregnancy, postnatal period,exclusive breastfeeding and PMTCT
Facilitate community-based participation in FeedingBuddy intervention and support role of buddies
Engage health staff to work with mothers and buddiesthroughout pregnancy and postnatal period
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Bridging Research and Implementation:
Preliminary Lessons Learned Early and continued engagement with policy makers.
Ensure alignment with national and provincial policies,priorities and needs.
Embed PMTCT research aims into comprehensive and
integrated maternal and child health programming. Alignment of program and research timelines.
Designing evaluation to target HIV+ study populationwithin the context of a comprehensive health project.
Planning study procedures and data collection to allowpending shift in PMTCT ARV prophylaxis policy.
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Thank-you, Thank-you, Thank-you Siyabonga!!
Improved health and development of children aged
02 years in selected communities.