{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:08:21Z","timestamp":1788973701170,"version":"build-2803163510"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"EDCTP2","award":["TMA2020CDF-3169-MTM-MI"],"award-info":[{"award-number":["TMA2020CDF-3169-MTM-MI"]}]},{"name":"Stellenbosch University temporary research assistance funding"},{"name":"South Africa Medical Research Council, Self-Initiated Research Grant"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int Breastfeed J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite efforts to promote optimal breastfeeding practices, the practice of exclusive breastfeeding is low in South Africa. We conducted a trial to determine whether text messaging plus motivational interviewing prolonged exclusive breastfeeding during the first six months of life and improved child health outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a randomized parallel group-controlled trial between July 2022 and May 2024, at a secondary-level healthcare facility. Mothers living with HIV, 18 years or older, initiating breastfeeding, on combination antiretroviral therapy (cART) and their infants were enrolled. The primary endpoint was exclusive breastfeeding from birth through week 24, based on the consecutive 24-hour food recall interviews. We compared differences in exclusive breastfeeding rates using a proportion test. Mothers who completely stopped breastfeeding were asked an open-ended question on reasons for stopping breastfeeding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Using block randomization mother-child pairs (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009276) were randomly allocated to receive intervention (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009138) or standard infant feeding counselling (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009138), of whom 105 and 101 mother-child pairs in the intervention group and standard care group, respectively, completed all four study visits. Exclusive breastfeeding rate at 24 weeks in the intervention group was 6% (6\/105) and 7% (7\/101) in the standard care group, rate difference \u2212\u20091% (95% CI -6\u20134%). Sixty-two of 276 mothers completely stopped breastfeeding, of whom 25% (34\/138) and 20% (28) were in the intervention group and standard care group, respectively. The most common reasons for stopping breastfeeding were the mother needing to return to work or look for work, 66% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200941). We also found that early breastfeeding cessation increased risk of child hospitalization or death compared to any form of breastfeeding to week 24, 10% (5\/48) versus 3% (5\/158),\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.055.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found no effect of the intervention on exclusive breastfeeding rates. Early cessation of breastfeeding was prevalent and maternal employment characteristics are important social determinants of breastfeeding behaviour. There is need for further research evaluating the effect of interventions that include financial incentives on breastfeeding practices among socioeconomically disadvantaged mothers. HIV services should reliably offer cART, consistently monitor viral load, and support mothers cART adherence, in settings where mixed feeding is common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>The trial was registered on ClinicalTrials.gov (NCT05063240) and Pan African Clinical Trial Registries (PACTR202110870407786) before recruitment of the first subject.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13006-024-00693-2","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T13:26:10Z","timestamp":1737379570000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A randomized controlled, trial on effects of mobile phone text messaging in combination with motivational interviewing versus standard infant feeding counselling on breastfeeding and child health outcomes, among women living with HIV"],"prefix":"10.1186","volume":"20","author":[{"given":"Moleen","family":"Zunza","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lehana","family":"Thabane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Kuhn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Els","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl","family":"Lombard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark F.","family":"Cotton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taryn","family":"Young","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,20]]},"reference":[{"issue":"10017","key":"693_CR1","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/S0140-6736(15)01024-7","volume":"387","author":"CG Victora","year":"2016","unstructured":"Victora CG, Bahl R, Barros AJD, Fran\u00e7a GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475\u201390.","journal-title":"Lancet"},{"issue":"10017","key":"693_CR2","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/S0140-6736(15)01044-2","volume":"387","author":"N Rollins","year":"2016","unstructured":"Rollins N, Bhandari N, Hajeebhoy N. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016;387(10017):491\u2013504.","journal-title":"Lancet"},{"key":"693_CR3","volume-title":"Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV","author":"World Health Organization, United Nations Children\u2019s Fund","year":"2016","unstructured":"World Health Organization, United Nations Children\u2019s Fund. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization; 2016."},{"issue":"Suppl 2","key":"693_CR4","doi-asserted-by":"publisher","first-page":"S115","DOI":"10.1097\/QAI.0000000000001343","volume":"75","author":"L Myer","year":"2017","unstructured":"Myer L, Phillips T. Beyond \u2018Option B+\u2019. J Acquir Immune Defic Syndr JAIDS. 2017;75(Suppl 2):S115\u201322.","journal-title":"J Acquir Immune Defic Syndr JAIDS"},{"issue":"1","key":"693_CR5","doi-asserted-by":"publisher","first-page":"a1079","DOI":"10.4102\/sajhivmed.v21i1.1079","volume":"21","author":"J Wessels","year":"2020","unstructured":"Wessels J, Sherman G, Bamford L. The updated South African National Guideline for the Prevention of Mother to Child Transmission of Communicable infections (2019). S Afr J HIV Med. 2020;21(1):a1079.","journal-title":"S Afr J HIV Med"},{"key":"693_CR6","unstructured":"Kufa-Chakezha T, Shangase N, Lombard C, Manda S, Puren A. November. The 2022 Antenatal HIV Sentinel Survey Key Findings. https:\/\/www.nicd.ac.za\/the-2022-antenatal-hiv-sentinel-survey. Accessed 16 2024."},{"issue":"10","key":"693_CR7","doi-asserted-by":"publisher","first-page":"e014145","DOI":"10.1136\/bmjopen-2016-014145","volume":"7","author":"AI Issaka","year":"2017","unstructured":"Issaka AI, Agho KE, Renzaho AMN. Prevalence of key breastfeeding indicators in 29 sub-saharan African countries: a meta-analysis of demographic and health surveys (2010\u20132015). BMJ Open. 2017;7(10):e014145.","journal-title":"BMJ Open"},{"issue":"2","key":"693_CR8","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1007\/s10995-019-02848-8","volume":"24","author":"JE Remmert","year":"2020","unstructured":"Remmert JE, Mosery N, Goodman G, Bangsberg DR, Safren SA, Smit JA, et al. Breastfeeding practices among women living with HIV in kwaZulu-Natal, South Africa: an observational study. Matern Child Health J. 2020;24(2):127\u201334.","journal-title":"Matern Child Health J"},{"issue":"3","key":"693_CR9","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/S2352-4642(19)30375-X","volume":"4","author":"S le Roux","year":"2020","unstructured":"le Roux S, Abrams E, Donald K, Brittain K, Phillips T, Zerbe A, et al. Infectious morbidity of breastfed, HIV-exposed uninfected infants under conditions of universal antiretroviral therapy in South Africa: a prospective cohort study. Lancet Child Adolesc Health. 2020;4(3):220\u201331.","journal-title":"Lancet Child Adolesc Health"},{"issue":"3","key":"693_CR10","doi-asserted-by":"publisher","first-page":"314","DOI":"10.1111\/mcn.12161","volume":"11","author":"EW Kimani-Murage","year":"2015","unstructured":"Kimani-Murage EW, Wekesah F, Wanjohi M, Kyobutungi C, Ezeh AC, Musoke RN, et al. Factors affecting actualisation of the WHO breastfeeding recommendations in urban poor settings in Kenya. Matern Child Nutr. 2015;11(3):314\u201332.","journal-title":"Matern Child Nutr"},{"key":"693_CR11","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/1746-4358-7-4","volume":"7","author":"AE Goga","year":"2012","unstructured":"Goga AE, Doherty T, Jackson DJ, Sanders D, Colvin M, Chopra M, et al. Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants - birth to 9 months. Int Breastfeed J. 2012;7:4.","journal-title":"Int Breastfeed J"},{"key":"693_CR12","unstructured":"South African National Department of Health. Guidelines for Vertical Transmission Prevention of Communicable Infections 2023. https:\/\/knowledgehub.health.gov.za\/elibrary\/guideline-vertical-transmission-prevention-communicable-infections. Accessed 16 November 2024."},{"issue":"9","key":"693_CR13","doi-asserted-by":"publisher","first-page":"2966","DOI":"10.1007\/s10461-018-2197-z","volume":"22","author":"DL Jones","year":"2018","unstructured":"Jones DL, Rodriguez VJ, Mandell LN, Lee TK, Weiss SM, Peltzer K. Influences on exclusive breastfeeding among rural HIV-infected South African women: cluster randomized control trial. AIDS Behav. 2018;22(9):2966\u201377.","journal-title":"AIDS Behav"},{"key":"693_CR14","first-page":"349394","volume":"2013","author":"S Iribarren","year":"2013","unstructured":"Iribarren S, Beck S, Pearce P, Chirico C, Etchevarria M, Cardinale D, Rubinstein F. TextTB: a mixed method pilot study evaluating acceptance, feasibility, and exploring initial efficacy of a text messaging intervention to support TB treatment adherence. Tuberc Res Treat. 2013;2013:349394.","journal-title":"Tuberc Res Treat"},{"issue":"5","key":"693_CR15","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1177\/193229681100500534","volume":"5","author":"J Dick","year":"2011","unstructured":"Dick J, Nundy S, Solomon M, Bishop K, Chin M, Peek M. Feasibility and usability of a text message-based program for diabetes self-management in an urban African-American population. J Diabetes Sci Technol. 2011;5(5):1246\u201354.","journal-title":"J Diabetes Sci Technol"},{"issue":"6","key":"693_CR16","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1097\/QAD.0b013e32834380c1","volume":"25","author":"C Pop-Eleches","year":"2011","unstructured":"Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825\u201334.","journal-title":"AIDS"},{"key":"693_CR17","volume-title":"Motivational interviewing: preparing people to change behaviour","author":"W Miller","year":"1991","unstructured":"Miller W, Rollnick S. Motivational interviewing: preparing people to change behaviour. New York: Guilford Press; 1991."},{"issue":"9","key":"693_CR18","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1111\/j.1467-789X.2011.00892.x","volume":"12","author":"MJ Armstrong","year":"2011","unstructured":"Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and\/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9):709\u201323.","journal-title":"Obes Rev"},{"issue":"2","key":"693_CR19","doi-asserted-by":"publisher","first-page":"228","DOI":"10.2174\/2589977515666230531154629","volume":"16","author":"E Sukmaningrum","year":"2024","unstructured":"Sukmaningrum E, Ayu AP, Wongso LV, Handayani M, Hendrianti S, Kawi NH, et al. Motivational interviewing as an intervention to improve antiretroviral treatment initiation among people who inject drugs (PWID): a pilot study in Jakarta and Bandung, Indonesia. Curr Drug Res Rev. 2024;16(2):228\u201336.","journal-title":"Curr Drug Res Rev"},{"issue":"9789","key":"693_CR20","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1016\/S0140-6736(11)60738-1","volume":"378","author":"T Tyllesk\u00e4r","year":"2011","unstructured":"Tyllesk\u00e4r T, Jackson D, Meda N, Engebretsen IMS, Chopra M, Diallo AH, et al. Exclusive breastfeeding promotion by peer counsellors in sub-saharan Africa (PROMISE-EBF): a cluster-randomised trial. Lancet. 2011;378(9789):420\u20137.","journal-title":"Lancet"},{"key":"693_CR21","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1186\/1471-2458-12-700","volume":"12","author":"JR Chinkonde","year":"2012","unstructured":"Chinkonde JR, Hem MH, Sundby J. HIV and infant feeding in Malawi: public health simplicity in complex social and cultural contexts. BMC Public Health. 2012;12:700.","journal-title":"BMC Public Health"},{"issue":"5","key":"693_CR22","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1089\/bfm.2016.0014","volume":"11","author":"BM Odeny","year":"2016","unstructured":"Odeny BM, Pfeiffer J, Farquhar C, Igonya EK, Gatuguta A, Kagwaini F, et al. The stigma of exclusive breastfeeding among both HIV-positive and HIV-negative women in Nairobi, Kenya. Breastfeed Med. 2016;11(5):252\u20138.","journal-title":"Breastfeed Med"},{"key":"693_CR23","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s13006-016-0068-7","volume":"11","author":"AN Hazemba","year":"2016","unstructured":"Hazemba AN, Ncama BP, Sithole SL. Promotion of exclusive breastfeeding among HIV-positive mothers: an exploratory qualitative study. Int Breastfeed J. 2016;11:9.","journal-title":"Int Breastfeed J"},{"key":"693_CR24","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1186\/s13063-023-07647-9","volume":"24","author":"M Zunza","year":"2023","unstructured":"Zunza M, Thabane L, Kuhn L, Els C, Cotton MF, Young T. Mobile phone text messaging plus motivational interviewing versus usual care: study protocol for a randomized controlled trial to evaluate effects on breastfeeding, child health, and survival outcomes, among women living with HIV (MTI-MI). Trials. 2023;24:639.","journal-title":"Trials"},{"key":"693_CR25","doi-asserted-by":"publisher","first-page":"c332","DOI":"10.1136\/bmj.c332","volume":"340","author":"KF Schulz","year":"2010","unstructured":"Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010;340:c332.","journal-title":"BMJ"},{"key":"693_CR26","volume-title":"Breastfeeding and replacement feeding practices in the context of mother-to-child transmission of HIV: an assessment tool for research and programs","author":"World Health Organization","year":"2001","unstructured":"World Health Organization. Breastfeeding and replacement feeding practices in the context of mother-to-child transmission of HIV: an assessment tool for research and programs. Geneva: WHO; 2001."},{"issue":"11","key":"693_CR27","doi-asserted-by":"publisher","first-page":"e028095","DOI":"10.1136\/bmjopen-2018-028095","volume":"9","author":"D Jackson","year":"2019","unstructured":"Jackson D, Swanevelder S, Doherty T, Lombard C, Bhardwaj S, Goga A. Changes in rates of early exclusive breastfeeding in South Africa from 201 to 2013: data from three national surveys before and during implementation of a change in national breastfeeding policy. BMJ Open. 2019;9(11):e028095.","journal-title":"BMJ Open"},{"issue":"Suppl 1","key":"693_CR28","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1007\/s10461-018-2208-0","volume":"22","author":"M Zunza","year":"2018","unstructured":"Zunza M, Esser M, Slograve A, Bettinger JA, Machekano R, Cotton M. Early Breastfeeding Cessation among HIVInfected and HIVUninfected women in Western Cape Province, South Africa. AIDS Behav. 2018;22(Suppl 1):114\u201320.","journal-title":"AIDS Behav"},{"key":"693_CR29","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/1471-2431-11-75","volume":"11","author":"M Nabulsi","year":"2011","unstructured":"Nabulsi M. Why are breastfeeding rates low in Lebanon? A qualitative study. BMC Pediatr. 2011;11:75.","journal-title":"BMC Pediatr"}],"container-title":["International Breastfeeding Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13006-024-00693-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13006-024-00693-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13006-024-00693-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T13:26:20Z","timestamp":1737379580000},"score":1,"resource":{"primary":{"URL":"https:\/\/internationalbreastfeedingjournal.biomedcentral.com\/articles\/10.1186\/s13006-024-00693-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,20]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["693"],"URL":"https:\/\/doi.org\/10.1186\/s13006-024-00693-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-5132328\/v1","asserted-by":"object"}]},"ISSN":["1746-4358"],"issn-type":[{"value":"1746-4358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,20]]},"assertion":[{"value":"22 September 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Stellenbosch University Human Research Ethics committee (reference M21\/03\/010) approved the study. Western Cape Department of Health approved access to Khayelitsha District Hospital for study recruitment (reference WC_202107_007). Mothers signed a written informed consent form for their and their child\u2019s participation in this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. Study results are presented in aggregate format in technical reports and journal publications. A model consent form is provided on request.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"List of study investigators: Prof Mark Cotton, Stellenbosch University; Dr Christine Els, Khayelitsha District Hospital; Prof Louise Kuhn, Columbia University; Prof Lehana Thabane, McMaster University; Prof Taryn Young, Stellenbosch University; Dr Moleen Zunza, Stellenbosch University. Independent data analyst: Dr Carl Lombard, Stellenbosch University. List of voting DSMB (Data Safety Monitoring Board) members: Prof Jonathan Levin (Chair), University of Witwatersrand, South Africa. Email: Jonathan.Levin@wits.ac.za; Prof Hassan Mahomed, Stellenbosch University, South Africa. Email: hmahomed@sun.ac.za; Prof Lawrence Mbuagbaw, McMaster University, Canada. Email: mbuagblc@mcmaster.ca; Prof Kennedy Otwombe, University of Witwatersrand, South Africa. Email: otwombek@phru.co.za; Dr Vundli Ramokolo, Medical Research Council, South Africa. Email: Vundli.Ramokolo@mrc.ac.za; Dr Elizabeth Spooner, Medical Research Council, South Africa. Email: Elizabeth.Spooner@mrc.ac.za.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 information"}}],"article-number":"5"}}