Issues in the design of a clinical trial with a behavioral intervention--the Zambia exclusive breast-feeding study.
OBJECTIVE
We present the rationale and design of the Zambian Exclusive Breast-feeding Study (ZEBS), a randomized trial evaluating the efficacy of short-duration exclusive breast-feeding (EBF) as a strategy to reduce postnatal human immunodeficiency virus (HIV) transmission while preserving the other health benefits of this important mode of infant feeding.


METHODS
One thousand two hundred HIV-positive pregnant women were recruited in Lusaka, Zambia, and followed with their infants for 24 months. In addition to Nevirapine (NVP), all women received intensive and frequent clinic- and home-based counseling to support exclusive breast-feeding. When the infant was 1 week of age, half of the women were randomly assigned to a group encouraged to abruptly (<24 h) cease all breast-feeding at 4 months. The primary outcome of the experimental (randomized) comparison is HIV-free survival at 24 months. The design is also observational and will compare HIV transmission rates between those who do and do not adhere to the counseling intervention promoting exclusive breast-feeding.


CONCLUSIONS
Our study aims to quantify the benefit-risk ratio of early cessation of exclusive breast-feeding to interrupt mother-to-child transmission of HIV with an intensive behavioral intervention and has both observational and experimental analytic approaches. Our study design assesses efficacy and also has a prominent applied component that if the intervention is effective, it will permit rapid and sustainable adoption within low-resource communities.
Center for International Health and Development, Boston University School of Public Health, 710 Albany Street, 715, Boston, MA 02118, USA. dthea@bu.edu
Donald M
DM
Thea
Cheswa
C
Vwalika
Prisca
P
Kasonde
Chipepo
C
Kankasa
Moses
M
Sinkala
Katherine
K
Semrau
Erin
E
Shutes
Christine
C
Ayash
Wei-Yann
WY
Tsai
Grace
G
Aldrovandi
Louise
L
Kuhn
D001521:Behavior Therapy / Q000379:methods*; D001942:Breast Feeding / Q000208:ethnology*; D003376:Counseling / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity / Q000453:epidemiology; D015438:Health Behavior; D006266:Health Education; D006293:Health Promotion; D006801:Humans; D007223:Infant; D011446:Prospective Studies; D015024:Zambia