Vertical Transmission Study

NCT01948557 | Completed DMC

• 1 other identifier: WT063009
• Study Type: interventional
• Target: 3,465
• Locations: 1 country
• Sites: 2

Brief Summary

Short courses of drugs can be given to HIV-infected pregnant women to reduce the chance of HIV infection being passed to her child either during pregnancy or during the labour process. However, children can also become infected by drinking the mother's breastmilk which contains the HIV virus. In many poor, developing countries in Africa, breastfeeding is the normal way of infant feeding and is vitally important because of the protection it gives to children from other diseases such as diarrhoea and malnutrition. Ideally there would be a way to make breastfeeding safer from HIV transmission without losing its other advantages. A medical study recently suggested that HIV-infected women who exclusively breastfed their children i.e. gave breastmilk but without any water, tea, formula milk or any solid foods did not pass on the virus to their children to the same degree as women who MBF with these other fluids and foods. It is important to confirm whether this observation is in fact true or not. We hypothesize that exclusive breastfeeding by HIV-infected mothers carries a lower risk of HIV transmission than mixed breastfeeding. We propose to follow 2,100 HIV-infected pregnant women and also some HIV-uninfected women from the time that they book at the clinic until 24 months of age. HIV-infected women who say they intend to breastfeed and all the HIV-uninfected women will be visited at their homes by breastfeeding counsellors both before and after delivery to support exclusive breastfeeding. HIV-infected women who choose not to breastfeed will be helped by clinic staff to safely replace all breastmilk with some other milk. An independent team will visit all mothers at their homes and collect information about the way they feed their children. Blood samples will be collected from the children at different times by a simple heel prick and the blood stored on a piece of filter paper. By testing these samples and comparing with the type of feeding at that time, we will be able to see when a child becomes infected and whether exclusive breastfeeding gives any protection.

Conditions

HIV

Keywords

Breastfeeding; Infants; Mother to child transmission of HIV; Survival

Outcome Measures

Primary Outcomes (3)

• HIV infection rates of infants who are Exclusively breastfed, Mixed Breastfed or Exclusive Formula Feeding as determined by HIV RNA PCR analysis of a blood sample at that time

  6 weeks of age

• HIV infection rates of infants who are Exclusively breastfed, Mixed Breastfed or Exclusive Formula Feeding as determined by HIV RNA PCR analysis of a blood sample at that time

  22 weeks of age

• Infant/child survival

  24 months of age

Secondary Outcomes (9)

• HIV infection rates of infants as determined by HIV RNA PCR analysis of a blood sample obtained in that time period

  Within 72 hours of birth

• Difference between intrauterine and intrapartum HIV infection rates in women and neonates receiving NVP as determined by HIV RNA PCR analysis of blood samples collected within 72 hours of birth and at 6 weeks

  72 hours and 6 weeks

• HIV infection rates of infants at various time points between 6 and 26 weeks, in relation to the type and duration of infant feeding practices i.e. EBF, MBF and EFF (+/- an initial period of EBF)

  6 weeks of age and 26 weeks of age

• HIV infection rates of infants 4 weeks after cessation of EBF as determined by HIV RNA PCR analysis of blood samples collected at that time

  4 weeks post cessation of breastfeeding

• Prevalent days of diarrhoea

  Weekly from birth to 9 months of age

Study Arms (1)

Infant feeding counselling and support

OTHER

All mothers provided with counselling. Subsequent support interventions depended on mothers' selection of feeding practice

Behavioral: Infant feeding counselling and support

Interventions

Infant feeding counselling and support BEHAVIORAL

Counselling of appropriate feeding practices as recommended in WHO/UNICEF/UNAIDS guidelines on HIV and infant feeding. Subsequent intensive, home-based support of exclusive breastfeeding or safe replacement feeding according to mothers' selection of feeding practice. Counselling contacts with mothers varied over time. 1-2 antenatal contacts. After delivery, home visits by infant feeding counsellors 3-4 times in first 2 weeks then every 2 weeks until 6 months. Outcome data collected by separate field based team who were blinded to mothers HIV status and infant feeding practice.

Infant feeding counselling and support

Eligibility Criteria

• Age: 16 Years+
• Sex: female
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• All pregnant women attending antenatal clinics in the Mpukunyoni and Hlabisa Tribal Areas of Hlabisa District or at Kwadabeka clinic or St Mary's hospital, Mariannhilll Hospital who offer consent to participate in the study

You may not qualify if:

• Intention to leave Hlabisa District or Kwadabeka community within 3 months of delivery.
• Failure to give consent.
• Less than 16 years of age.

Sponsors & Collaborators

• University of KwaZulu: lead
• Wellcome Trust: collaborator

Study Sites (2)

Kwadabeka health centre

Durban, KwaZulu-Natal, South Africa

Location

Africa Centre for Health and Population Studies

Somkele, KwaZulu-Natal, South Africa

Location

Related Publications (17)

• Bland R, Coovadia H, Coutsoudis A, Rollins N, Newell M. Cohort profile: mamanengane or the Africa centre vertical transmission study. Int J Epidemiol. 2010 Apr;39(2):351-60. doi: 10.1093/ije/dyp165. Epub 2009 Mar 31. No abstract available.

  PMID: 19336438 BACKGROUND

• Neveu D, Viljoen J, Bland RM, Nagot N, Danaviah S, Coutsoudis A, Rollins NC, Coovadia HM, Van de Perre P, Newell ML. Cumulative exposure to cell-free HIV in breast milk, rather than feeding pattern per se, identifies postnatally infected infants. Clin Infect Dis. 2011 Mar 15;52(6):819-25. doi: 10.1093/cid/ciq203.

  PMID: 21367736 RESULT

• Patel D, Bland R, Coovadia H, Rollins N, Coutsoudis A, Newell ML. Breastfeeding, HIV status and weights in South African children: a comparison of HIV-exposed and unexposed children. AIDS. 2010 Jan 28;24(3):437-45. doi: 10.1097/QAD.0b013e3283345f91.

  PMID: 19915445 RESULT

• Becquet R, Bland R, Leroy V, Rollins NC, Ekouevi DK, Coutsoudis A, Dabis F, Coovadia HM, Salamon R, Newell ML. Duration, pattern of breastfeeding and postnatal transmission of HIV: pooled analysis of individual data from West and South African cohorts. PLoS One. 2009 Oct 16;4(10):e7397. doi: 10.1371/journal.pone.0007397.

  PMID: 19834601 RESULT

• Rollins NC, Becquet R, Bland RM, Coutsoudis A, Coovadia HM, Newell ML. Infant feeding, HIV transmission and mortality at 18 months: the need for appropriate choices by mothers and prioritization within programmes. AIDS. 2008 Nov 12;22(17):2349-57. doi: 10.1097/QAD.0b013e328312c740.

  PMID: 18981775 RESULT

• Desmond C, Bland RM, Boyce G, Coovadia HM, Coutsoudis A, Rollins N, Newell ML. Scaling-up exclusive breastfeeding support programmes: the example of KwaZulu-Natal. PLoS One. 2008 Jun 18;3(6):e2454. doi: 10.1371/journal.pone.0002454.

  PMID: 18560596 RESULT

• Bland RM, Little KE, Coovadia HM, Coutsoudis A, Rollins NC, Newell ML. Intervention to promote exclusive breast-feeding for the first 6 months of life in a high HIV prevalence area. AIDS. 2008 Apr 23;22(7):883-91. doi: 10.1097/QAD.0b013e3282f768de.

  PMID: 18427207 RESULT

• Lebon A, Bland RM, Rollins NC, Coutsoudis A, Coovadia H, Newell ML. Short communication: CD4 counts of HIV-infected pregnant women and their infected children--implications for PMTCT and treatment programmes. Trop Med Int Health. 2007 Dec;12(12):1472-4. doi: 10.1111/j.1365-3156.2007.01954.x.

  PMID: 18076554 RESULT

• Bland RM, Becquet R, Rollins NC, Coutsoudis A, Coovadia HM, Newell ML. Breast health problems are rare in both HIV-infected and HIV-uninfected women who receive counseling and support for breast-feeding in South Africa. Clin Infect Dis. 2007 Dec 1;45(11):1502-10. doi: 10.1086/523320. Epub 2007 Oct 22.

  PMID: 17990235 RESULT

• Bland RM, Rollins NC, Coovadia HM, Coutsoudis A, Newell ML. Infant feeding counselling for HIV-infected and uninfected women: appropriateness of choice and practice. Bull World Health Organ. 2007 Apr;85(4):289-96. doi: 10.2471/blt.06.032441.

  PMID: 17546310 RESULT

• Coovadia HM, Rollins NC, Bland RM, Little K, Coutsoudis A, Bennish ML, Newell ML. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet. 2007 Mar 31;369(9567):1107-16. doi: 10.1016/S0140-6736(07)60283-9.

  PMID: 17398310 RESULT

• Rollins NC, Coovadia HM, Bland RM, Coutsoudis A, Bennish ML, Patel D, Newell ML. Pregnancy outcomes in HIV-infected and uninfected women in rural and urban South Africa. J Acquir Immune Defic Syndr. 2007 Mar 1;44(3):321-8. doi: 10.1097/QAI.0b013e31802ea4b0.

  PMID: 17195768 RESULT

• Thairu LN, Pelto GH, Rollins NC, Bland RM, Ntshangase N. Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal, South Africa. Matern Child Nutr. 2005 Jan;1(1):2-10. doi: 10.1111/j.1740-8709.2004.00001.x.

  PMID: 16881874 RESULT

• Shah S, Rollins NC, Bland R; Child Health Group. Breastfeeding knowledge among health workers in rural South Africa. J Trop Pediatr. 2005 Feb;51(1):33-8. doi: 10.1093/tropej/fmh071. Epub 2004 Dec 15.

  PMID: 15601651 RESULT

• Bland RM, Rollins NC, Van den Broeck J, Coovadia HM; Child Health Group. The use of non-prescribed medication in the first 3 months of life in rural South Africa. Trop Med Int Health. 2004 Jan;9(1):118-24. doi: 10.1046/j.1365-3156.2003.01148.x.

  PMID: 14728615 RESULT

• Rollins NC, Dedicoat M, Danaviah S, Page T, Bishop K, Kleinschmidt I, Coovadia HM, Cassol SA; Child Health Group. Prevalence, incidence, and mother-to-child transmission of HIV-1 in rural South Africa. Lancet. 2002 Aug 3;360(9330):389. doi: 10.1016/s0140-6736(02)09599-5.

  PMID: 12241784 RESULT

• Bland RM, Rollins NC, Coutsoudis A, Coovadia HM; Child Health Group. Breastfeeding practices in an area of high HIV prevalence in rural South Africa. Acta Paediatr. 2002;91(6):704-11. doi: 10.1080/080352502760069151.

  PMID: 12162606 RESULT

MeSH Terms

Conditions

Breast Feeding

Interventions

Palliative Care

Condition Hierarchy (Ancestors)

Feeding Behavior; Behavior

Intervention Hierarchy (Ancestors)

Patient Care; Therapeutics; Health Services; Health Care Facilities Workforce and Services

Study Officials

• Hoosen M Coovadia, MB

  University of KwaZulu-Natal, and University of the Witwatersand, South Africa

  PRINCIPAL INVESTIGATOR

• Marie Louise Newell, PhD

  University of KwaZulu-Natal and Institute for Child Health, University College, London

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 18, 2013
• First Posted: September 23, 2013
• Study Start: October 1, 2001
• Primary Completion: September 1, 2005
• Study Completion: October 1, 2006
• Last Updated: September 23, 2013

Record last verified: 2013-09

Locations

ZA (2)