(P24-042-24) Engaging Family Members to Support Optimal Care and Feeding Practices for Children Who Are HIV Exposed but Uninfected

Objectives: Consistent with the WHO, the Government of the Republic of Zambia recommends exclusive breastfeeding (EBF) for 6 months for women living with HIV (WLWH). Children who are HIV-exposed but uninfected (CHEU) are at increased risk for poor growth, health, and development compared to children who are HIV-unexposed and uninfected. We evaluated the acceptability of engaging family members, including male partners, to support WLWH to exclusively breastfeed and participate in responsive caregiving.

Methods: We conducted qualitative research using Trials of Improved Practices (TIPs) following participants over time as they tried recommended behaviors. We recruited WLWH with infants 1-2 months of age and their male partners or other family members in Lusaka, Zambia. At visit 1, WLWH described current infant feeding and caregiving practices. At visit 2, WLWH and their family members received tailored counseling on EBF and responsive caregiving. After 2-3 weeks, at visit 3, WLWH and their families reported their experiences trying recommended care and feeding practices. We analyzed interview transcripts thematically using Atlas.ti.

Results: Participants included 23 WLWH and 23 family members (15 male partners, 8 female family members) as home supporters. Although ART adherence was high, fears of HIV transmission during breastfeeding were a barrier to EBF. WLWH also reported insufficient breastmilk, which led to giving other foods and liquids and breastfeeding less frequently. After trying recommendations, almost all WLWH described improved infant feeding practices and reduced worries of HIV transmission. Home supporters reported encouraging EBF and practicing recommended responsive care and stimulation practices. Home supporters valued being more involved and learning about infant care and feeding. Male partners described increased bonding with their infants. WLWH appreciated increased family member support.

Conclusions: Tailored counseling and increased family support for WLWH has the potential to improve EBF and responsive care and stimulation. Future interventions should consider integrating nutrition and child development and using a family-centered approach to support WLWH and CHEU.

Funding Sources: National Institute of Allergy and Infectious Disease (NIAID) through the UNC Chapel Hill Center for AIDS Research