NDP is based on the notion that integrated improved counselling - face-to-face sharing of information - on infant feeding, maternal nutrition, and antiretroviral (ARV) prophylaxis in health care and community services can enable women to make informed choices and to act effectively to feed their infants optimally in the context of HIV prevalence.

NDP drew on interpersonal communication, printed materials, partnership, and research in an effort to impact on CT uptake and to facilitate the introduction of ARV prophylaxis. Actvities included involvement of provincial health offices in planning and implementation, the introduction of a group counseling model, streamlined data collection, additional human resources for CT, and development of messages and materials to support CT. LINKAGES did not directly implement these interventions but, rather, provided training, materials, and technical assistance to enable government, non-governmental organisation (NGO), and community partners to promote and support informed infant feeding and prevention of mother-to-child transmission (PMTCT) of HIV/AIDS practices. The project also tested programmatic interventions in three districts to strengthen maternal and newborn care services in target health facilities.

Specifically, the components of the project’s integrated model were:

• Formative research through focus group discussions, household trials, in-depth interviews, and surveys of mothers and families to gather information on knowledge, attitudes, beliefs, practices, and the local context for infant feeding decisions
• Training in infant feeding in the context of PMTCT and skills building for programme managers, health providers, and community workers in counseling, negotiation, and community outreach
• Advocacy for national policy to protect and support safe infant feeding practices and integrated PMTCT that included application of the Global Strategy for Infant and Young Child Feeding, the Baby-Friendly Hospital Initiative, and the International Code of Marketing of Breast-milk Substitutes
• Behaviour change communication (BCC) to develop appropriate targeted strategies, messages, media, and community and health centre activities to help mothers make informed infant feeding and reproductive health decisions
• Assessment and strengthening of community capacity for counseling and referrals
• Monitoring and evaluation through collecting and analysing data with local partners on key infant feeding and PMTCT indicators before and after interventions to improve programme planning.

Children, Women, HIV/AIDS, Nutrition, Health.

LINKAGES is a United States Agency for International Development (USAID)- funded programme providing technical information, assistance, and training to organisations on breastfeeding. LINKAGES is managed by the Academy for Educational Development (AED).

In 1997, LINKAGES made an assessment visit to Zambia with the Central Board of Health (CBOH) through the National Food and Nutrition Commission (NFNC). Responding to an NFNC request for assistance in developing guidelines for the National Policy on Breastfeeding Practices and HIV/AIDS Transmission from Mother to Child, LINKAGES reviewed PMTCT efforts and identified resources needed to implement the proposed policy.

First implemented in an antenatal clinic in Ndola District, other districts - including Kitwe in Copperbelt Province, Kabwe and Kapiri-Mposhi in Central Province, and Livingstone and Choma in Southern Province - expressed interest in the project and in 2001 the government requested its expansion. By June 2005, LINKAGES had scaled up to 60 sites in 6 districts in 3 provinces. Site assessment was also carried out in 4 additional districts in anticipation of future PMTCT implementation.

“The skills, tools, and lessons emerging from LINKAGES’ eight-year involvement in Zambia have helped over a dozen African countries begin to overcome the challenge of infant feeding in the context of HIV/AIDS.” Specifically, results from baseline and end-line surveys in two districts showed that HIV counseling and testing uptake increased significantly among mothers. The proportion of mothers who reported being tested for HIV increased from 7% in 2002 to 48% in 2004 in Livingstone District and from 5% in 2000 to 46% in 2004 in Ndola. Exclusive breastfeeding also rose, from 50% in 2002 to 64% in 2004 in Livingstone and from 57%t in 2000 to 74% in 2004 in Ndola.

According to organisers, NDP also:

• Fostered national dialogue on HIV and infant feeding policy issues that led to donor and government support for inclusion of infant feeding in PMTCT programmes
• Supported the national mandate to make HIV counseling and voluntary testing a routine service, and introduced multiple measures to protect the confidentiality of clients
• Focused attention on a) the importance of quality MCH care in PMTCT programmes by retraining midwives and counsellors in antenatal care, labour and delivery, and post-partum care, and b) on including MCH indicators in monthly data collection
• Developed formative research and BCC materials and tools that will be of use to other PMTCT programmes
• Enhanced the knowledge and skills of health providers and community members for improved services and referral, community outreach, and follow-up care and support for HIV-positive mothers and their infants.