Engaging Family Members to Support Exclusive Breastfeeding, Responsive care, and Antiretroviral Therapy Adherence Among Families with Children who are HIV-Exposed and Uninfected

Children who are HIV-exposed and uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. To support families with CHEU, we assessed the acceptability of engaging family members to support women living with HIV (WLWH) with exclusive breastfeeding (EBF) and antiretroviral therapy (ART) adherence and to engage in responsive infant caregiving. We conducted trials of improved practices, a consultative research approach, that follows participants over time as they try recommended behaviors. We enrolled postpartum women in Lusaka, Zambia, who identified home supporters. At visit 1, WLWH were interviewed about current practices. At visit 2, WLWH and home supporters received tailored EBF, responsive care, and ART adherence counseling. At visit 3, WLWH and home supporters were interviewed about their experiences trying recommended practices for 2-3 weeks. Interview transcripts were analyzed thematically. Participants included 23 WLWH, 15 male partners, and 8 female family members. WLWH reported several barriers to EBF. The most common were fear of HIV transmission via breastfeeding-despite high ART adherence-and insufficient breastmilk. After counseling, WLWH reported less fear of HIV transmission and improved breastfeeding practices. Home supporters reported providing WLWH increased support for EBF and ART adherence and practicing responsive caregiving. Both male and female home supporters appreciated being included in counseling and more involved in caregiving, and WLWH valued the increased support. Families with CHEU need focused support. Tailored counseling and family support for WLWH show promise for improving EBF, responsive caregiving, and ART adherence. Los ni & ntilde;os expuestos al VIH no infectados (ENI) tienen un mayor riesgo de tener un crecimiento, una salud y un desarrollo deficientes. Evaluamos la aceptabilidad de involucrar a los miembros de la familia para apoyar a las madres que viven con el VIH con la lactancia materna exclusiva y el cumplimiento de la terapia antirretroviral y as & iacute; como para participar en un cuidado cari & ntilde;oso y sensible. Trials of Improved Practices (TIPs) es un enfoque de investigaci & oacute;n consultiva que sigue a los participantes mientras prueban los comportamientos recomendados. Inscribimos a mujeres con bebes menores de 3 meses que viven con el VIH en Lusaka, Zambia, que identificaron miembros de sus familias para que las apoyaban. En la visita 1, se entrevist & oacute; a madres sobre las pr & aacute;cticas actuales. En la visita 2, las madres y los miembros de sus familias recibieron asesoramiento personalizada. En la visita 3, se entrevist & oacute; a las madres y a los miembros de sus familias sobre sus experiencias al probar los comportamientos recomendados. Las entrevistas se analizaron tem & aacute;ticamente. Los participantes incluyeron 23 madres, 15 esposos y 8 familiares femeninas. Madres informaron sobre obst & aacute;culos a la lactancia materna, siendo los m & aacute;s comunes fueron el miedo a la transmisi & oacute;n del VIH a trav & eacute;s de la lactancia materna (a pesar del alto cumplimiento de la terapia antirretroviral) y la falta de leche materna. Despu & eacute;s del asesoramiento, las mujeres informaron menos miedo a la transmisi & oacute;n del VIH, mejores pr & aacute;cticas de lactancia materna, y m & aacute;s apoyo de sus familiares. El apoyo familiar y el asesoramiento personalizado son estrategias potenciales para apoyar a las madres que viven con el VIH.