Abstract
BackgroundSouth Africa recently phased out access to free formula milk in the public sector in support of breastfeeding for women living with HIV. Few women living with HIV in South Africa choose breastfeeding and among those who do, many stop breastfeeding early. We sought to explore the feasibility of using mobile phone text messaging coupled with motivational interviewing to enhance adherence to breastfeeding practices.Methods and designA randomized, parallel group, single-center pilot trial. Electronic sequence generation and random allocation will be done centrally. Women of low socioeconomic status, from Cape Town, South Africa will be randomly assigned within 24 h of giving birth at a primary healthcare clinic to a structured weekly text message plus motivational interviewing and usual standard of care, using a permutation of different block sizes. Criteria for feasibility success will include: five participants recruited per week (over 12 weeks), about 75% of all eligible participants consent for study participation, complete evaluation of outcomes in at least 70% of all recruited participants, breastfeeding adherence rates of at least 70% in the intervention group, six months after delivery. Participants will be evaluated soon after giving birth and post-delivery at weeks 2, 6, 10, and 24. Primary analysis will follow the “intention-to-treat” principle. Sub-group analysis will be used to assess sub-group effects.DiscussionThis pilot trial will evaluate the feasibility of conducting a larger trial on communication and support approaches to improve adherence to breastfeeding by HIV-infected women. Text messaging and motivational interviewing are simple interventions which may allow participants to access personalized adherence advice and support.Trial registrationClinicalTrials.gov: NCT02949713. Registered on 26 October 2016; Pan African Clinical Trial Registry PACTR201611001855404. Registered on 8 November 2016.
Highlights
South Africa recently phased out access to free formula milk in the public sector in support of breastfeeding for women living with Human immunodeficiency virus (HIV)
This pilot trial will evaluate the feasibility of conducting a larger trial on communication and support approaches to improve adherence to breastfeeding by HIV-infected women
We found that few HIV-infected women chose to breastfeed; among those who did, many (50%) switched to formula feeding early [18]
Summary
In resource-limited settings, where child mortality is mainly due to diarrhea, pneumonia, and malnutrition, the effectiveness of antiretroviral treatment (ART) in reducing the risk of HIV transmission through breastfeeding has largely resolved the dilemma on how HIV-infected women should feed their infants [2,3,4] In such settings, the World Health Organization (WHO) recommends at least 12 months of breastfeeding with infant or maternal ART [5, 6]. South Africa, a country with a high prevalence of HIV, recently phased out access to free formula milk in the public sector in support of breastfeeding for women living with HIV. Developing simple interventions to promote and sustain continued breastfeeding by women is a public health priority
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