Mobile phone text messaging plus motivational interviewing: effects on breastfeeding , child health and survival outcomes, a group sequential randomised standard of care controlled trial (MTM-MI)

In 2010, following global HIV and infant feeding guidelines, the South African vertical transmission prevention of HIV program withdrew provision of free formula milk and adopted “Option B+” strategy into policy, where women living with HIV are put on combination antiretroviral treatment, irrespective of CD4 count, which has to be maintained at least for the duration of breastfeeding or as lifelong treatment.

HIV exposed uninfected children born to women living with HIV have increased mortality during infancy and morbidity due to common childhood infections than infants born to women without HIV.

Breastfeeding provides considerable protection against childhood mortality from diarrhea disease and respiratory tract infections. Lack of breastfeeding, at a minimum, doubles the risk of infant death in the first six months of life.

Many infants in low resourced settings at high risk of infectious disease morbidity and death are deprived of the immunological and nutritional benefits of breast milk, through an attenuated duration of breast milk exposure in attempts to possibly lessen the risk of postnatal HIV transmission. South Africa has one of the lowest exclusive breastfeeding rates in Africa, 8% in infants under 6 months of age.

Mobile phone text messaging as a simple, low-cost intervention improves medication adherence among HIV-infected, diabetic, and tuberculosis patients.

Motivational interviewing has been beneficial across many health problems, including HIV viral load suppression, body weight loss, and alcohol and tobacco use. Combining a number of intervention approaches is more likely to influence behaviour change than an individual approach.

We propose a clinical trial to determine whether text messaging combined with motivational interviewing sustain continued breastfeeding and whether the combined intervention contributes to improved infant health outcomes.

We assume that continued breastfeeding is sustained among women living with HIV receiving weekly text messages combined with motivational interviewing and that this contributes to improved infant health outcomes.

Thus, this study will contribute towards achieving the Sustainable Development Goal 3 call for an ‘end to preventable deaths of newborns and children under five years.' Objectives: 1.

To determine the effects of mobile phone text messaging combined with motivational interviewing versus standard of care on: (a) Continued exclusive breastfeeding to six month of child age, (b) Continued any form of breastfeeding to 6 month of child age. 2.

To determine the contribution of the combined intervention on improved infant health outcomes: (a) Infant morbidity (all –cause hospitalization) and all –cause death, (b) Infant growth.