title: Acceptability of a nipple shield delivery system administering antiviral agents to prevent mother-to-child transmission of HIV through breastfeeding.
abstract: BACKGROUND
  Breastfeeding is a route of mother-to-child transmission (MTCT) of the human immunodeficiency virus (HIV). The World Health Organization recommends antiretroviral (ARV) prophylaxis as the best method to prevent mother-to-child transmission of HIV (PMTCT) during breastfeeding. The nipple shield delivery system (NSDS) is being developed as an accessible method to deliver ARVs to infants and PMTCT during breastfeeding. The NSDS can potentially circumvent hygiene and storage issues in delivering drugs to infants in low-resource settings.
  
  
  OBJECTIVE
  The primary objective was to determine acceptability of the NSDS for PMTCT in Kenya. Secondary objectives included assessing mothers' understanding of MTCT and identifying cultural and implementation issues that might affect NSDS acceptability.
  
  
  METHODS
  Eleven focus group discussions were conducted, each group consisting of 7 to 12 participants. Seven focus group discussions consisted of HIV-positive mothers, 2 included grandmothers/mothers-in-law, and 2 included fathers/husbands. Ten in-depth interviews were also conducted with individual maternal/child health care providers. Topics included infant feeding and HIV stigma, as well as safety, effectiveness, and feasibility of the NSDS. Device prototypes were used in discussions.
  
  
  RESULTS
  Participants felt that the NSDS could be trusted if validated scientifically and promoted by health care professionals. HIV-related stigma, access, efficacy, and hygiene were identified as important considerations for acceptance.
  
  
  CONCLUSIONS
  The NSDS is a potentially acceptable method of PMTCT during breastfeeding. Further studies are needed to confirm acceptability, safety, and efficacy. For NSDS adoption to PMTCT, strategies will need to be developed to minimize HIV-related stigma and to ensure that continuous hygiene of the device is maintained.
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Catherine W
authors.initials: CW
authors.lastname: Hart
authors.affiliation: PATH, Seattle, WA, USA.
authors.forename: Kiersten A
authors.initials: KA
authors.lastname: Israel-Ballard
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Carol L
authors.initials: CL
authors.lastname: Joanis
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Mary Lynn
authors.initials: ML
authors.lastname: Baniecki
authors.affiliation: PATH, Nairobi, Kenya.
authors.forename: Florence
authors.initials: F
authors.lastname: Thungu
authors.affiliation: Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK chart@fhi360.org stephen.gerrard@cantab.net.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gerrard
authors.affiliation: Continuum, West Newton, MA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kneen
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Sokal
mesh_terms: D000284:Administration, Oral; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001942:Breast Feeding; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008297:Male; D008875:Middle Aged; D008895:Milk, Human; D009558:Nipples; D017060:Patient Satisfaction
chemical_list: D019380:Anti-HIV Agents
keywords: Kenya; acceptability; breast milk; breastfeeding; human immunodeficiency virus; mother-to-child transmission; nipple shield delivery system