Acceptability of formula-feeding to prevent HIV postnatal transmission, Abidjan, Côte d’Ivoire: ANRS 1201/1202 Ditrame Plus study

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Study Justification:
The study aimed to investigate the acceptability of formula-feeding as a means to prevent postnatal HIV transmission in Abidjan, Côte d’Ivoire. This was an important area of research as it provided insights into the attitudes and choices of HIV-infected pregnant women regarding infant feeding options. Understanding the factors influencing their decision-making process could help inform policies and interventions to reduce HIV transmission rates.
Highlights:
– 97% of the HIV-infected pregnant women expressed their infant-feeding choice before delivery.
– 53% of the women chose formula-feeding as their preferred option.
– Factors associated with refusing formula-feeding included living with a partner, being Muslim, having a low educational level, not disclosing HIV status, and being included in the study within the first 6 months.
– Among the 295 mothers who formula-fed, the success rate of formula-feeding was 93.6% at Day 2 and 84.2% at 12 months.
– Only 15.6% of women breast-fed at least once, with temporary mixed-feeding occurring in some cases due to social stigma or newborn health issues.
Recommendations:
Based on the findings, the study suggests that in settings with access to clean water, structured antenatal counseling, and provision of free formula, formula-feeding can be an acceptable option for HIV-infected women. However, the long-term health outcomes for both mother and child need to be considered when making recommendations on infant-feeding practices in African urban settings.
Key Role Players:
1. Healthcare providers: Responsible for providing structured antenatal counseling and support to HIV-infected pregnant women.
2. Policy makers: Involved in developing and implementing policies related to infant-feeding options for HIV-infected women.
3. Community leaders and religious figures: Play a role in addressing social stigma associated with formula-feeding and promoting acceptance.
4. NGOs and international organizations: Provide support and resources for the provision of free formula and other necessary interventions.
Cost Items for Planning Recommendations:
1. Provision of free formula: Budget allocation for the procurement and distribution of formula to HIV-infected women up to the age of 9 months.
2. Antenatal counseling services: Funding for training healthcare providers and establishing counseling programs.
3. Monitoring and evaluation: Resources for tracking the success rates of formula-feeding and assessing long-term health outcomes.
4. Awareness campaigns: Budget for community education and awareness initiatives to address social stigma and promote acceptance of formula-feeding.
Please note that the cost items provided are general categories and not specific cost estimates.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study provides quantitative data on the acceptability of formula-feeding to prevent HIV postnatal transmission in Abidjan, Côte d’Ivoire. The study includes a large sample size (580 women) and analyzes determinants of acceptability using logistic regression. The study also reports the success rate of formula-feeding (93.6% at Day 2 and 84.2% at 12 months) and the rate of mixed-feeding (15.6%). However, the abstract does not provide information on the methodology used to collect data or potential limitations of the study. To improve the evidence, the abstract could include more details on the study design, data collection methods, and potential biases. Additionally, it would be helpful to include information on the statistical significance of the findings and any recommendations for future research or interventions.

OBJECTIVE: To describe the maternal acceptability of formula-feeding proposed to reduce postnatal HIV transmission in Abidjan, Côte d’Ivoire. METHODS: Each consenting HIV-infected pregnant women, age ≥18 years, who received a perinatal antiretroviral prophylaxis was eligible. Two hierarchical infant-feeding options were proposed antenatally: exclusive formula-feeding or short-term exclusive breast-feeding. Formula-feeding was provided free up to age 9 months. Determinants of acceptability were analyzed using a logistic regression. Formula-feeding failure was defined as having breast-fed one’s child at least once. RESULTS: Between March 2001 and March 2003, 580 women delivered: 97% expressed their infant-feeding choice before delivery; 53% chose formula-feeding. Significant prenatal determinants for refusing formula-feeding were: living with her partner, being Muslim, having a low educational level, being followed in one of the study sites, having not disclosed her HIV status, and having been included within the first 6 months of the project. Among the 295 mothers who formula-fed, the Kaplan-Meier probability of success of the formula-feeding option was 93.6% at Day 2 (95% confidence interval [CI]: 90.7% to 96.3%) and 84.2% at 12 months (95% CI: 79.9% to 88.5%): 46 of 295 (15.6%) women breast-fed at least once, of whom 41% temporarily practiced mixed-feeding at Day 2 because of social stigma or newborn poor health. CONCLUSIONS: In settings with general access to clean water, structured antenatal counseling, and sustained provision of free formula, slightly over half of HIV-infected women chose to artificially feed their newborn infant. Low mixed-feeding rates were observed. This social acceptability must be balanced with mother-child long-term health outcomes to guide safe recommendations on infant-feeding among HIV-infected women in African urban settings. © 2007 Lippincott Williams & Wilkins, Inc.

The study titled “Acceptability of formula-feeding to prevent HIV postnatal transmission, Abidjan, Côte d’Ivoire: ANRS 1201/1202 Ditrame Plus study” explores the maternal acceptability of formula-feeding as a means to reduce postnatal HIV transmission in Abidjan, Côte d’Ivoire. The study found the following innovations and recommendations to improve access to maternal health:

1. Structured Antenatal Counseling: Providing structured counseling sessions to HIV-infected pregnant women can help educate them about the benefits and risks of different infant-feeding options. This can empower women to make informed decisions regarding formula-feeding or exclusive breastfeeding.

2. Free Provision of Formula: Ensuring free provision of formula up to the age of 9 months can remove financial barriers and make formula-feeding a viable option for HIV-infected women. This can improve access to formula and reduce the risk of postnatal HIV transmission.

3. Addressing Social Stigma: Addressing social stigma associated with formula-feeding can help reduce mixed-feeding rates. Providing support and education to mothers can help them overcome societal pressures and choose the best feeding option for their child’s health.

4. Long-Term Health Outcomes: Balancing the social acceptability of formula-feeding with long-term health outcomes for both mothers and children is crucial. Further research is needed to guide safe recommendations on infant-feeding among HIV-infected women in African urban settings.

These innovations and recommendations aim to improve access to maternal health by providing HIV-infected women with information, support, and resources to make informed decisions about infant-feeding options.
AI Innovations Description
The study titled “Acceptability of formula-feeding to prevent HIV postnatal transmission, Abidjan, Côte d’Ivoire: ANRS 1201/1202 Ditrame Plus study” aimed to describe the maternal acceptability of formula-feeding as a means to reduce postnatal HIV transmission in Abidjan, Côte d’Ivoire. The study involved HIV-infected pregnant women who received perinatal antiretroviral prophylaxis. Two infant-feeding options were proposed: exclusive formula-feeding or short-term exclusive breast-feeding. Formula-feeding was provided free of charge up to 9 months of age. The determinants of acceptability were analyzed using logistic regression.

The study found that 53% of the women chose formula-feeding as their preferred option. Prenatal determinants for refusing formula-feeding included living with a partner, being Muslim, having a low educational level, being followed in one of the study sites, not disclosing HIV status, and being included within the first 6 months of the project. Among the 295 mothers who formula-fed, the success rate of formula-feeding was 93.6% at Day 2 and 84.2% at 12 months. Only 15.6% of women breast-fed at least once, with some temporarily practicing mixed-feeding due to social stigma or newborn poor health.

The study concluded that in settings with access to clean water, structured antenatal counseling, and sustained provision of free formula, slightly over half of HIV-infected women chose to formula-feed their infants. Low rates of mixed-feeding were observed. The social acceptability of formula-feeding needs to be balanced with long-term health outcomes for both mother and child to guide safe recommendations on infant-feeding among HIV-infected women in African urban settings.
AI Innovations Methodology
Based on the provided description, one potential innovation to improve access to maternal health could be the development of a mobile application or online platform that provides comprehensive information and support for HIV-infected pregnant women in African urban settings. This innovation could include features such as:

1. Educational resources: The application or platform could provide easily accessible and culturally sensitive information about HIV transmission, prevention, and infant-feeding options. This would help women make informed decisions about formula-feeding or breastfeeding.

2. Decision-making support: The innovation could include interactive tools that guide women through the decision-making process, taking into account their individual circumstances, preferences, and cultural beliefs. This would help women feel empowered and supported in making the best choice for themselves and their infants.

3. Peer support and counseling: The application or platform could facilitate virtual support groups or connect women with trained counselors who can provide emotional support and answer their questions or concerns. This would help alleviate any anxieties or uncertainties they may have about their infant-feeding choice.

4. Tracking and reminders: The innovation could include features that help women track their infant-feeding practices, medication adherence, and clinic appointments. It could also send reminders and notifications to ensure they receive timely support and follow-up care.

To simulate the impact of this innovation on improving access to maternal health, a methodology could be developed as follows:

1. Define the target population: Identify the specific group of HIV-infected pregnant women in African urban settings who would benefit from this innovation.

2. Collect baseline data: Gather information about the current access to maternal health services, infant-feeding practices, and maternal health outcomes in the target population. This could involve surveys, interviews, or analysis of existing data sources.

3. Develop a simulation model: Create a mathematical or computational model that represents the target population and simulates the impact of the innovation on various outcomes, such as the proportion of women choosing formula-feeding, adherence to infant-feeding practices, and maternal health outcomes.

4. Input data and parameters: Input the baseline data collected in step 2 into the simulation model. Define the parameters and assumptions related to the innovation, such as the expected uptake of the mobile application or online platform, the effectiveness of the educational resources, and the level of engagement with peer support and counseling.

5. Run simulations: Use the simulation model to run multiple iterations, varying the input parameters to explore different scenarios and assess the potential impact of the innovation on improving access to maternal health.

6. Analyze results: Analyze the simulation results to evaluate the potential benefits and limitations of the innovation. This could involve comparing outcomes between different scenarios, identifying key factors influencing the impact, and assessing the cost-effectiveness of the innovation.

7. Refine and validate the model: Incorporate feedback from stakeholders, experts, and the target population to refine and validate the simulation model. This iterative process ensures that the model accurately represents the real-world context and provides reliable insights.

By following this methodology, researchers and policymakers can gain valuable insights into the potential impact of the recommended innovation on improving access to maternal health for HIV-infected pregnant women in African urban settings.

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