A collateral benefit could be that donor milk banks may heighten breastfeeding awareness in the community at large
Wet Nursing Novel Drug To Reduce Pmtct
WET NURSING - A NOVEL DRUG TO REDUCE PMTCT GROUP- 4
CONTENTS Background – why this is a critical research problem? Research question (s) / issue Aim of the research Study design a. Description of intervention b.Phases of intervention c.Pre-intervention / preparatory phase (scoping / baseline studies, capacity building, SA, etc.) d.Implementation phase – Methodology e.Evaluation phase – indicators and monitoring framework Expected outcome (Theory of Change) Ethical issues Timeline
BACKGROUND Mother-to-child transmission - Transmission of HIV from an HIV-positive mother to her child during pregnancy, labor, delivery or breastfeeding Without treatment, around 15-30 percent of babies born to HIV-infected women will become infected with HIV during pregnancy and delivery. A further 5- 20 percent will become infected through breastfeeding.
BACKGROUND For most babies, breastfeeding is without question the best way to be fed, but unfortunately breastfeeding can also transmit HIV. If no antiretroviral drugs are being taken, breastfeeding for two or more years can double the risk of the baby becoming infected to around 40 percent Replacement feeding at the same time –INCREASES RISK OF DIARRHOEA. As extended breastfeeding and mixed feeding is only safe when antiretroviral drugs are taken, there is now an emphasis on using antiretroviral drugs to prevent the baby becoming infected as well as an emphasis on breastfeeding.. But Nevirapine and lamivudine given to mothers are transmitted to infants via breastfeeding in quantities sufficient to have biologic effects on the virus; this may lead to an increased risk of a breastfed infants development of resistance to maternal antiretrovirals and cause other ARV side effects
THE ISSUE 27 million pregnancies per year* 0.7% prevalence**1,89,000 infected pregnancies per year 30% transmissionCohort of 56,700 infected newborns per year*Derived from population estimates (SRS) AND Crude Birth rate, adding 10% pregnancy wastage**Weighted average of estimates numbers of rural and urban HIV prevalence amongst women15-19 years
RESEARCH QUESTION How effective is Milk Bank in reducing mother to child HIV transmission due to breastfeeding in the state of Andhra Pradesh?
AIM To reduce the prevalence of HIV transmission from mother to child due to breastfeeding from 5-20% to 0-1% by introducing human milk banking system.
OBJECTIVESGENERAL OBJECTIVESTo compare the effect of donated bottled milk with infected mother’s bottled milk in the state Andhra PradeshSPECIFIC OBJECTIVES To find out if mothers would feel comfortable with their child being fed donated breast milk if they were unable to breast feed. To find out if donor mothers would be comfortable to donate milk. To find out various barriers attached to milk donation. To assess that milk banking can reduce the risk of HIV transmission from mother to child. To explore the scope of health voucher incentives in encouraging milk donation.
HYPOTHESIS Donated milk will reduce the risk of transmission of HIV from mother to child.
HEALTH BELIEF MODEL Perceived Susceptibility- emotional bond Perceived benefits- save an infants life Perceived Severity- chest congestion, hardening of breasts, chances of breast cancer, purity of milk Perceived barriers- cultural issues, psychosocial issues Cues to threat- incentives
DESCRIPTION OF INTERVENTION Breastfeeding is the normal way to feed infants by providing them with adequate amount of nutrients that they need for healthy growth and development. But in case if mothers are infected from HIV infection than the best possible solution to deal with this is to provide them milk through Human Milk Banking System (wet nursing). Encouraging more and more donors to be part of this intervention by giving them health voucher incentives. This intervention would play a major role in reducing the risk of transmitting HIV infection from mother to child and would lead to safe and secure child bearing.
TI - PMTCT Incentives-Referrals donors Storage mothers Screening andDonors Processing Distribution milk Recipient-Screenin non- Collection g infected children
PRE - INTERVENTION PHASE I: Base line Survey- Focus Group Discussion with donor mothers and receivers PHASE II: Selection of donor/funding agencies PHASE III: Promotion through IEC Material among the Donor mothers through SBA/TBA /ASHA/ANM/DOCTORS Referrals Pre-testing of IEC Material for both PHASE IV: Giving them details about the incentives i.e. cash incentive of Rs. 500 for each bottle giving a kit for their new born child dry ration card with fenugreek seeds
PHASE IV: Pilot testing of intervention- feasibilitystudy, scalability study, reliability studyPHASE V:Informed Consent from the donor mothers andethical consent from IRB PHASE V: Initial screening of donor mothers to donate excess breast milk and ensure that donor mother is not suffering from any of the communicable diseases PHASE VII: Medical confirmation form quality of product ensuring through the medical provider of donor mother and her infants pediatrician a confirmation form from doctor ensuring that both mother and baby are healthy and mother can donate her excess milk.
PRE - INTERVENTIONPHASE VIII: Donor Testing Donor Test Kit will be posted at their homes (free of cost) contain blood testing instrument and DNA screening Screening blood test DNA in the milk will be matched with the DNA identity profile make sure that milk donor is the same who are being screened if they are donating through different medium of transport.
STAKEHOLDERS Donor and receiver mother and their families Child birth Educator, Nursing mother group Local TI- NGOs and CBOs Health Care Providers: social worker, nurses, nursing assistant doctors International Donors/Agencies ( USAID, World Bank, UNITAID, PEPFAR) Media Professionals Policy Makers Business/Finance Professionals State Medical Providers
STAKEHOLDER MAPPING KEEP SATISFIEDHIGH MANAGE CLOSELYPOWER MONITOR KEEP INFORMEDLOW LO HIGH INTREST W
CAPACITY BUILDINGPERSONNELS METHODPEER EDUCATOR Demonstration, ManualsDOCTORS WorkshopOUT-REACH WORKERS Demonstration, ManualsCHILD BIRTH EDUCATOR Training WorkshopPROGRAM OFFICERS Training Workshop, Management WorkshopCOUNCELLORS WorkshopMONITORING AND EVALUATION Data collection toolsTEAM
IMPLEMENTATION PHASE Study Area: Andhra Pradesh Study design: Randomized Control Trial Sampling method: Cluster Sampling Method Sampling Size: Two groups would be selected randomly from the targeted population i.e. children with HIV infected mothers and they are randomly divided into experimental and non- experimental group. one group of children would be given donated milk and others would be receiving infected mothers bottled milk
Children with HIV infected mothers Randomization Receive infected Received donated mother’s bottled bottled milk milk NonDisease Non Disease Disease d Diseased d d
MONTHLY MONITROING AND EVALUATION PHASES.No Materials Number1. Number of IEC Material Distributed2. Number of donor mother’s milk screened3. Number of mother’s milk received from other sources3. Number of donated milk distributed4. Number of vouchers provided5. Number of milk bottle to be met by our project
EXPECTED OUTCOME Reduction in HIV transmission from mother to child from 5-20% to 1% Awareness about importance of breast-feeding among the mass population.
ETHICAL CONSIDERATIONS Pasteurizedhuman donor breast milk will only be prescribed following written informed consent from a parent or guardian. Privacy and confidentiality Precaution and risk minimization Professional competence Totality of responsibility; and compliance with ethical concerns
TIMELINE Our project will take 6 months for completion