Effects of lipolysis or heat treatment on HIV-1 provirus in breast milk

Translating global recommendations on HIV and infant feeding to the local context: the development of culturally sensitive counselling tools in the Kilimanjaro Region, Tanzania

BACKGROUND

This paper describes the process used to develop an integrated set of culturally sensitive, evidence-based counselling tools (job aids) by using qualitative participatory research. The aim of the intervention was to contribute to improving infant feeding counselling services for HIV positive women in the Kilimanjaro Region of Tanzania.

METHODS

Formative research using a combination of qualitative methods preceded the development of the intervention and mapped existing practices, perceptions and attitudes towards HIV and infant feeding (HIV/IF) among mothers, counsellors and community members. Intervention Mapping (IM) protocol guided the development of the overall intervention strategy. Theories of behaviour change, a review of the international HIV/IF guidelines and formative research findings contributed to the definition of performance and learning objectives. Key communication messages and colourful graphic illustrations related to infant feeding in the context of HIV were then developed and/or adapted from existing generic materials. Draft materials were field tested with intended audiences and subjected to stakeholder technical review.

RESULTS

An integrated set of infant feeding counselling tools, referred to as 'job aids', was developed and included brochures on feeding methods that were found to be socially and culturally acceptable, a Question and Answer Guide for counsellors, a counselling card on the risk of transmission of HIV, and an infant feeding toolbox for demonstration. Each brochure describes the steps to ensure safer infant feeding using simple language and images based on local ideas and resources. The brochures are meant to serve as both a reference material during infant feeding counselling in the ongoing prevention of mother to child transmission (pMTCT) of HIV programme and as take home material for the mother.

CONCLUSION

The study underscores the importance of formative research and a systematic theory based approach to developing an intervention aimed at improving counselling and changing customary feeding practices. The identification of perceived barriers and facilitators for change contributed to developing the key counselling messages and graphics, reflecting the socio-economic reality, cultural beliefs and norms of mothers and their significant others.

Inactivation of HIV-1 in breast milk by treatment with the alkyl sulfate microbicide sodium dodecyl sulfate (SDS)

BACKGROUND

Reducing transmission of HIV-1 through breast milk is needed to help decrease the burden of pediatric HIV/AIDS in society. We have previously reported that alkyl sulfates (i.e., sodium dodecyl sulfate, SDS) are microbicidal against HIV-1 at low concentrations, are biodegradable, have little/no toxicity and are inexpensive. Therefore, they may be used for treatment of HIV-1 infected breast milk. In this report, human milk was artificially infected by adding to it HIV-1 (cell-free or cell-associated) and treated with

RESULTS

SDS (>or=0.1%) was virucidal against cell-free and cell-associated HIV-1 in breast milk. SDS could be substantially removed from breast milk, without recovery of viral infectivity. Viral load in artificially infected milk was reduced to undetectable levels after treatment with 0.1% SDS. SDS was virucidal against HIV-1 in human milk and could be removed from breast milk if necessary. Milk was not infectious after SDS removal.

CONCLUSION

The proposed treatment concentrations are within reported safe limits for ingestion of SDS by children of 1 g/kg/day. Therefore, use of alkyl sulfate microbicides, such as SDS, to treat HIV1-infected breast milk may be a novel alternative to help prevent/reduce transmission of HIV-1 through breastfeeding.

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MESH Headings

• Adult
• Anti-HIV Agents/pharmacology
• CD4 Antigens/metabolism
• Cell Line
• Female
• HIV Infections/transmission
• HIV Infections/virology
• HIV-1/drug effects
• HIV-1/pathogenicity
• HeLa Cells
• Humans
• Infectious Disease Transmission, Vertical/prevention & control
• Milk, Human/drug effects
• Milk, Human/virology
• Sodium Dodecyl Sulfate/pharmacology
• Surface-Active Agents/pharmacology
• T-Lymphocytes/virology

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Grants

• F32 HD041346 NICHD NIH HHS
• F32 HD41346 NICHD NIH HHS
• P01 AI37829 NIAID NIH HHS

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Affiliation(s)

Sandra Urdaneta Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA Department of Bioscience and Biotechnology, Drexel University, College of Medicine, Philadelphia, Pennsylvania 19104 USA
Brian Wigdahl Department of Microbiology and Immunology, Institute for Molecular Medicine and Infectious Diseases, Drexel University, College of Medicine, Philadelphia, Pennsylvania 19104 USA
Elizabeth B Neely Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
Cheston M Berlin Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA Department of Pharmacology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
Cara-Lynne Schengrund Department of Biochemistry, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
Hung-Mo Lin Department of Health Evaluation Sciences, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA
Mary K Howett Department of Microbiology and Immunology, Penn State College of Medicine, Hershey, Pennsylvania 17033 USA Department of Bioscience and Biotechnology, Drexel University, College of Medicine, Philadelphia, Pennsylvania 19104 USA

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