title: Growth in late infancy among HIV-exposed children in urban Haiti is associated with participation in a clinic-based infant feeding support intervention.
abstract: The integration of nutrition support for infants of HIV-infected mothers is a recognized need; however, the evidence for effective programmatic solutions is weak. The objective of our study was to implement and evaluate a new infant feeding support intervention for HIV-exposed, uninfected, non-breast-fed infants 6-12 mo of age attending the Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) pediatric clinic in Port-au-Prince, Haiti. The 24-wk intervention included a lipid-based nutrient supplement, education, promotion of existing clinical services, and social support. We compared growth outcomes among intervention participants (n = 73) at start (wk 0) and end (wk 24) of intervention to a historical control group of HIV-exposed infants seen at the GHESKIO in the year prior to the intervention who would have met the intervention entrance criteria (n = 294). The intervention and historical control groups did not differ significantly at age 6 mo (wk 0). At age 12 mo (wk 24), the intervention group had a lower prevalence of underweight and stunting than the historical control group (weight-for-age Z-score < -2 SD: 6.8 vs. 20.8%, P = 0.007; length-for-age Z-score < -2 SD: 9.6 vs. 21.2%, P = 0.029). Wasting tended to be lower in the intervention group than the historical control (weight-for-length Z-score < -2 SD: 2.9 vs. 8.9%, P = 0.11). Implementation of the intervention was associated with reduced risk of growth faltering in HIV-exposed uninfected children from 6 to 12 mo of age. This is a promising intervention model that can be adapted and scaled-up to other HIV care contexts.
authors.affiliation: Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA. rah@cornell.edu
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Heidkamp
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Stoltzfus
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Fitzgerald
authors.forename: Jean W
authors.initials: JW
authors.lastname: Pape
mesh_terms: D000554:Ambulatory Care Facilities; D001827:Body Height; D001835:Body Weight; D002657:Child Development; D003430:Cross-Sectional Studies; D019587:Dietary Supplements / Q000032:analysis; D005260:Female; D005522:Food Services; D005527:Food, Fortified / Q000032:analysis; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000503:physiopathology; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D015995:Prevalence; D012306:Risk; D013851:Thinness / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D014504:Urban Health; D019282:Wasting Syndrome / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*