Maisha Mabibi:
“Life Grandmothers” of Kenya
Presented by:
Chandice Covington, PhD, RN,
PNP (BC), FAAN, Interim Dean,
Professor and Florence Thelma
Hall Endowed Chair for Nursing
Excellence in Women’s Health
Texas Tech University Health
Sciences Center Anita Thigpen
Perry School of Nursing
Acknowledgements:
Objectives

Describe the problem of infant feeding in
developing countries where HIV is a significant
concern.

List possible technologies, including the role of
grandmothers, to address infant feeding concerns
when the mother is HIV positive.

Project the potential efficacy of technologies to
address infant feeding and HIV.
Problem

Globally, 600,000 infants are infected with HIV each
year.
 Less than 100 in US by perinatal transmission.

> 80% of new infections are in Africa.
 1,600 new pediatric infections every day globally.
 > 1000 in one ‘county’ of Kenya alone annually.

The rate of mother-to-child HIV transmission varies
between 10% and 45%.

MTCT is responsible for all HIV infections and 10% of
all new HIV infections worldwide.
http://www.unicef.org/programme/breastfeeding/feeding.htm
LIFE GRANDMOTHERS 2010\UNICEF in action.pdf
Risk of HIV Transmission
Shorter duration of breastfeeding
Longer breastfed HIV-positive mother/baby,
higher risk of HIV infection.
BF 6 months ~ 1/3 risk BF 2 yrs
 Exclusive breastfeeding in the early months
Immunological “war” factors in human milk,
of HIV-infected
exclusive breastfeeding, 1st 3 months of life
resulted in a lower risk of MTCT vs. mixed
feeding)

SOURCES:
http://www.unicef.org/programme/breastfeeding/hiv.htm
Associations between breast milk viral load, mastitis, exclusive breastfeeding, and postnatal transmission of HIV.
Risk of HIV Transmission

Prevention and treatment of breast
problems
 Mastitis & cracked nipples associated with increased risk of
HIV-transmission

Prevention of HIV-infection during
breastfeeding
Initial maternal viral load higher subsequent to new
infection; increased child risk of infection (2nd infection
risk superinfection)

Early treatment of infant oral thrush
Infant oral sores hasten infectivity
SOURCES:
http://www.hhmi.org/news/walker.html
http://www.medscape.com/viewarticle/718849
Lunney KM, Iliff P, Mutasa K, Ntozini R, Magder LS, Moulton LH, Humphrey
JH. Clin Infect Dis. 2010 Mar 1;50(5):762-9.
Are there Practical Solutions?
1.Determine feasibility of global
practices of surrogate feeding for
example by grandmothers?
2.Feasibility of a strategy such as a
therapeutic breast shield/filter
tailored to the uniqueness of the
maternal-child dyad feeding
relationship?
Presentation Reports:
1.
Maisha Mabibi
Grandmother Relactation Project,
Malindi, Kenya.
2.
Phase 1 development of
an Anti-HIV Breast
Shield, Cupron, Inc.,
Nairobi, Kenya.
MAISHA MABIBI STUDY
Funded by the Glaser Pediatric
AIDS Foundation and the UCLA
School of Nursing
Maisha Mabibi Study
 AIM: Determine if multiparous, non‐pregnant,
seronegative [‐] women at the grandmother
stage‐of‐life (35 – 70 years of age) could
re‐establish a nutritious/adequate milk supply
equivalent in essential nutrient bioavailability to
mother’s milk through a re-lactation protocol.
11
Maisha Mabibi Study
Criteria: BF @ least 1 child 6 mos, weaned 6 mos, not PG, neg for
HIV & severe anemia
 N=35/29, 6 dropped
◦ Age Mean = 49 (Range 35 – 72 years)
◦ Bf Mean = 6.7 children (Range 1-14)
◦ BF duration Mean = 2 years (Range .75 – 4.0 years)
12
Methods: Setting
 Malindi District of
coastal province of
Kenya 300,000
population
 Tribes: Huntersgatherers: BANTUS
Mijikenda (Digo,
Duruma, Rabai, Ribe,
Kambe, Jibana,
Chonyi, Giriama,
Kauma), Taveta,
Pokomo, Taita
 Religion: Muslim,
Prostestant,
Indigenous, Mixed
Methods: Procedure
 Informed consent
 Blood test for baseline
hemoglobin and nutritional
factors
 Determination of HIV
negative status
 Urine test to rule out
pregnancy
 Health and reproductive
history
AIM 1: Re-Lactation TrialProcedure
◦ Participants use
re-lactation
methods 8-weeks
◦ Testing of breast
fluids
◦ Nutritional
quantity &
quality
Results

Living breast milk cells in GM’s milk
Results:
Total
Protein
Mature Human Milk= 8 - 9 mg/ml (LIT)
Colostrum=2.95 mg/ml (LIT)
GM mean = 27.5 mg/ml, Range=8.96 - 56.72
DA mean = 11.25 mg/ml, Range=7.05 - 14.55
Pooled Protein Comparisons
Total Protein mg/ml
60.00
27.26
mg/ml
50.00
20.02
40.00
30.00
20.00
14.76
11.12
10.00
0.00
Daughter GM Protein
Protein
Milk-like
GM
Pooled Protein
Colostrumlike GM
Texas Tech University Health Sciences
Center chandice.covington@ttuhsc.edu
20
Lactation Hormones of the PostMenopausal Woman




Prolactin – remains stable
Oxytocin - increases
Estrogen: Levels drop
Re-modeling of breast
tissue continues, resident
stem cells in breast
bioactive over lifetime
(Russo et al. 2006)

Breast developmental
research of the last few
years support a apocrine,
daughter-cell lined breast
duct that retains an “process
memory” for lactation (Russo
& Russo, 2004).
Grandmother Hypothesis:
Re-visited
The data support that
grandmothers may
serve a "evolutionary
loophole" function to
circumvent mortality
and morbidity in
children in AIDSimpacted populations.
Breastmilk Shield to Prevent
HIV Transmission
Phase 1 – Proof of
Principle
AIM: Anti-HIV Breast Shield
Establish proof-of-principle by
the examination of breast milk
after passing through a copper
oxide based filter device.
R&D goal to develop an at-the-
breast shield to deactivate HIV
in breast milk.
Anti-HIV Breast Shield
Study Design
Study Site: Selected City Council Maternity
Clinics, Nairobi, Kenya
Study Objective: Demonstrate an in vitro
reduction of HIV-1 infectivity in whole,
skim, cell-free or skim and cell-free breast
milk by passage of the milk through copper
oxide containing filters.
Study Design: Sample
50 HIV-1 seropositive women
18-40 years old
HIV positive prenatally
Birth to 1 year postpartum
No maternal ARV for 2 weeks prior to
study entrance
Study Design Cont’d
 Data collection:
 Blood sample for viral load
 Women with plasma viral
load greater than 50,000
HIV RNA copies per ml
donate 1/2 cup of breast
milk.
Primary Study Goals
Demonstrate at least 2 and 3 log reductions
in in vitro viral infections in wild type
HIV-1 in whole and cell-free breast milk
filtered through the copper oxide
containing filters.

Determine the amounts of copper
oxide needed in the filters to
successfully achieve the primary
outcome.
Dr. Gadi Borkow, PI
Experiment: Passing thru Filter
Next Steps: Phase II
Phase 2 of Study Planned if
‘Proof of Principle’
demonstrated:

Develop breast shield equipped
with copper filter to prevent HIV
transmission via breastfeeding
drawing upon scientists in
medical engineering.
Next Steps: Phase II
Phase 2 of Study Planned if
‘Proof of Principle’
demonstrated:

Safety studies in animal models
on copper (regulated naturally
in humans). Rare copper
disorders.
Next Steps: Phase II
Confirm that the copper filter does not
degrade natural nutritional and antiinfective components of breast milk
during filtration process via lab studies
on pumped milk that is then passed
through filter.

Issues:
 Wilson disease (1:55,000 US births, excess CU)
 Menkes disease (1:298,000, deficient CU)
 Inherited disorders of copper transport
Future Studies (Phase III)

Demonstrate the general,
and developmental
nontoxicity of the filter.

Develop a filter strategy
tailored to the uniqueness
of the maternal-child dyad
feeding relationship
within cultural sanctions
of resource-poor societies.
Progress to Date
 Milk
sample are being analyzed in
Kenya Aids Vaccination Initiative
(KAVI) laboratory in Nairobi, Kenya.
 Report
due shortly to the Bill &
Melinda Gates Foundation.
 420,000 new
infections
 + 10 years =
4,200,000 more cases
related to MTCT;
 HIV(-) grandmother ?;
 Cultural influences
on surrogate/shield;
Potential Efficacy of Technologies
vs. Continuing Questions
Human
adaptability;
Community role