Feasibility and Acceptability of a Novel Intervention to Improve Infant and Young Child Feeding Counseling for HIV‐Positive Women in Malawi
Authors: Flax Valerie , Hamela Gloria , Mofolo Innocent , Mokiwa Lemekeza , Mgoli Patience , Swira Henry , Hosseinipour Mina , Hoffman Irving , Maman Suzanne 
Published: November 2023

The purpose of this study was to test the feasibility and acceptability of a novel intervention to improve infant and young child feeding (IYCF) counseling for HIV‐positive women with children < 24 months in Malawi. The intervention was designed to address formative findings that identified the following priority areas: improving community‐based social support for HIV‐positive women to carry out recommended IYCF practices, ameliorating food insecurity in households affected by HIV, and including husbands in IYCF counseling. UNC Project‐Malawi collaborated with CARE‐Malawi to train village savings and loan association (VSLA) volunteer leaders in Lilongwe District to conduct 15 learning sessions on IYCF during regular VSLA meetings. The IYCF activity was layered onto a USAID‐funded program that integrated HIV‐positive women into existing VSLAs as a way of improving their access to livelihoods. To assess the feasibility and acceptability of the intervention, we conducted observations of volunteers leading learning sessions, collected logs of their activities, and conducted in‐depth interviews with 9 VSLA volunteers, 12 VSLA members (6 HIV‐positive and 6 HIV‐negative), and 12 husbands of members. Following the training, volunteers held learning sessions with approximately 450 VSLA members in 35 groups. The groups were largely comprised of women, one‐quarter of whom were pregnant or breastfeeding. Only 6% of members were men. On average, about 80% of members were present at each learning session. VSLA volunteers uniformly reported that they enjoyed conducting the learning sessions and thought that group members benefited from them. The volunteers suggested reducing the number of breastfeeding learning sessions because they contained repetitive information, while they recommended expanding the number of complementary feeding sessions because a few of them took longer than the suggested time (20 minutes) to complete. Both HIV‐positive and HIV‐negative members found the information useful and liked having messages for HIV‐positive women incorporated into the sessions. They felt this helped them understand that IYCF recommendations in Malawi are the same for all women, regardless of HIV status. Volunteers and members suggested that additional topics, like HIV stigma, could be incorporated into the sessions. Although they were invited to participate in 3 sessions, few husbands attended them. They explained that they were shy to participate in group meetings dominated by women and considered IYCF to be within their wives’ purview. In conclusion, integrating IYCF learning sessions into VSLAs was feasible and acceptable for VSLA volunteers and for HIV‐positive and HIV‐negative members. The intervention could be improved with minor changes to the learning sessions. Other strategies should be tested to make the meetings more male friendly or to provide different types of opportunities for men to learn about IYCF.Support or Funding InformationNIH BIRCWH K12 program, UNC CFAR developmental award