"It has changed my life": unconditional cash transfers and personalized infant feeding support- a feasibility intervention trial among women living with HIV in western Kenya.

BACKGROUND: The syndemic effects of poverty, food insecurity and living with HIV are recognized as global health priorities, including through the United Nations Sustainability Goals 1, 2 and 3. Today, women and girls account for 63% of all new HIV infections in eastern and southern Africa, including Kenya. Pregnant and postpartum women living with HIV in this setting face unique challenges including increased financial insecurity as women leave the work force to care for their newborn infants. This contributes to poverty, food scarcity and stress. METHODS: To address financial insecurity, improve infant feeding and reduce stress among mothers living with HIV in this setting, we developed a multilevel intervention, Supporting Healthy Mothers, consisting of 10 monthly unconditional cash transfers (10,000 KES, ~$75 USD/month) and personalized infant feeding support from pregnancy to 7 months postpartum. We conducted a non-randomized feasibility trial of this intervention among women engaged in HIV care in Kisumu, Kenya. From February 23, 2022 to March 23, 2022, we enrolled a total of 40 women who were 20-35 weeks pregnant-20 women to the intervention group at a public clinic, and 20 women to the control group at a similar clinic. Our aim was to assess feasibility, acceptability, and the potential impact of the intervention on food security, infant feeding and maternal mental health. RESULTS: Analyzing data from all 40 participants, we found a significant reduction in food insecurity scores from baseline for the intervention group when compared to the control group at 6 weeks and 6 months postpartum (p = 0.0008 and p < 0.0001, respectively). Qualitative exit interviews with intervention group participants confirmed women felt more financially secure and had newly acquired practical knowledge and skills related to infant feeding. Women found the two intervention components highly acceptable and described an overall positive impact on wellbeing. CONCLUSIONS: The Supporting Healthy Mothers intervention has potential to positively impact women across the perinatal period and beyond by increasing financial security and supporting women to overcome infant feeding challenges and should be assessed in larger trials. TRIAL REGISTRATION: Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, initially published on February 1, 2022. CLINICALTRIALS: gov ID: NCT05219552 Protocol ID: K23MH116807.

Feasibility, acceptability and lessons learned from an infant feeding intervention trial among women living with HIV in western Kenya.

BACKGROUND: The World Health Organization recommends mothers breastfeed exclusively for the first six months of their infant's life. However, women living with HIV in low resource settings face many barriers to recommended infant feeding practices such as fear of HIV transmission and perceived milk insufficiency. Moreover, current support for breastfeeding in this context is often insufficient to overcome these barriers. To support women's infant feeding experience, we tested a personalized infant feeding support program among perinatal women living with HIV in Kenya. METHODS: Supporting Healthy Mothers is a theory and evidence-based multilevel intervention designed to address the mental health burden associated with financial and food insecurity and provide personalized support for optimal infant feeding postpartum. As part of the Supporting Healthy Mothers intervention feasibility trial, between February 23, 2022 and November 9, 2022, twenty mothers received five personalized infant feeding support sessions delivered by a local professional lactation specialist from pregnancy until three months postpartum. Through detailed observations of these sessions, clinical notes and repeated team discussions, we aimed to describe and provide a limited evaluation of these sessions. We identified the strengths and limitations of the lactation support sessions as well as areas for future development. RESULTS: Participation in the sessions was high and at three months postpartum all participants reported exclusive breastfeeding as recommended despite experiencing a myriad of challenges. Having face-to-face and frequent early postpartum sessions, being available to field participant concerns between sessions and measuring infant weights at each session were key strengths. Continuing sessions beyond three months postpartum and incorporating family planning and general maternal health counseling topics would enhance these supportive sessions. CONCLUSIONS: The personalized professional infant feeding support sessions were highly acceptable and feasible to implement. In-person sessions, in a clinic setting provided opportunities to evaluate and adjust breastfeeding technique and led to successful exclusive breastfeeding practice. Future interventions should consider integrating with other perinatal care services and offering support on demand and immediately postpartum. TRIAL REGISTRATION: Supporting Healthy Mothers was registered with ClinicalTrials.gov Protocol Registration and Results System, posted on February 2, 2022. Identifiers: NCT05219552 Unique Protocol ID: K23MH116807.

The feasibility, time savings and economic impact of a designated time appointment system at a busy HIV care clinic in Kenya: a randomized controlled trial.

INTRODUCTION: As efforts are made to reach universal access to ART in Kenya, the problem of congestion at HIV care clinics is likely to worsen. We evaluated the feasibility and the economic benefits of a designated time appointment system as a solution to decongest HIV care clinics. METHODS: This was an explanatory two-arm open-label randomized controlled trial that enrolled 354 consenting participants during their normal clinic days and followed-up at subsequent clinic appointments for up to nine months. Intervention arm participants were given specific dates and times to arrive at the clinic for their next appointment while those in the control arm were only given the date and had the discretion to decide on the time to arrive as is the standard practice. At follow-up visits, we recorded arrival and departure times and asked the monetary value of work participants engaged in before and after clinic. We conducted multiple imputation to replace missing data in our primary outcome variables to allow for intention-to-treat analysis; and analyzed the data using Mann-Whitney U test. RESULTS: Overall, 72.1% of the intervention participants arrived on time, 13.3% arrived ahead of time and 14.6% arrived past scheduled time. Intervention arm participants spent a median of 65 [interquartile range (IQR), 52-87] minutes at the clinic compared to 197 (IQR, 173-225) minutes for control participants (p<0.01). Furthermore, intervention arm participants were more productively engaged on their clinic days valuing their cumulative work at a median of USD 10.5 (IQR, 60.0-16.8) compared to participants enrolled in the control arm who valued their work at USD 8.3 (IQR, 5.5-12.9; p=0.02). CONCLUSIONS: A designated time appointment system is feasible and provides substantial time savings associated with greater economic productivity for HIV patients attending a busy HIV care clinic.