RESUMO
We describe the results of a pilot randomized clinical trial of a mobile phone-based intervention, InTSHA: Interactive Transition Support for Adolescents with HIV, compared to standard care. Encrypted, closed group chats delivered via WhatsApp provided peer support and improved communication between adolescents with HIV, their caregivers, and healthcare providers. We randomized 80 South African adolescents ages 15 to 19 years with perinatally-acquired HIV to receive either the intervention (n=40) or standard of care (n=40). We measured acceptability (Acceptability of Intervention Measure [AIM]) and feasibility (Feasibility of Intervention Measure [FIM]) as primary outcomes. We evaluated impact on retention in care and viral suppression six months after randomization as secondary endpoints. We performed bivariable and multivariable analyses using logistic regression models to assess the effect of the InTSHA intervention compared to standard of care. Among the adolescents randomized to the InTSHA intervention, the median AIM was 4.1/5.0 (82%) and median FIM was 3.9/5.0 (78%). We found no difference in retention in care or in viral suppression comparing intervention and control groups. Among adolescents who attended three or more sessions, retention in care was 100% at 6 months. InTSHA is an acceptable and feasible mHealth intervention warranting further study in a larger population.
RESUMO
The aim of this study was to investigate the effect of time, temperature, and thickener on expressed human milk thickened for infants with dysphagia. Thickening agents included raw oatmeal cereal, commercial thickeners (Gelmix, Purathick), pureed fruits, pureed vegetables, yogurt, and pudding. The International Dysphagia Diet Standardisation Initiative (IDDSI) flow test was used to measure the thickness level across samples at various temperatures (40 °F/4.4 °C, 70 °F/21.1 °C, and 98.6 °F/37 °C) and times (0, 5, 10, and 20 min). Statistical analysis included one-way ANOVA with Tukey post hoc test and multiple linear regression. Fruit purees, particularly banana, achieved the thickest mixtures at all temperatures and maintained a similar thickness over time (20 min). Vegetable puree mixtures were minimally effective at thickening, i.e., between 0 and 1 ml on IDDSI flow test, with exception of squash at 40 °F/4.4 °C. Commercial thickener (Gelmix and Purathick) mixtures continued to thicken over time. The yogurt mixture at 40 °F/4.4 °C thickened initially and thinned slightly over time. The pudding mixture at 40 °F/4.4 °C thickened immediately but quickly became a thin liquid. The raw oatmeal cereal mixtures thinned or thickened over time dependent on the temperature of the human milk (40 °F/4.4 °C mixture thinned over time, while the 70 °F/21.1 °C, and 98.6 °F/37 °C mixtures thickened over time). CONCLUSION: Time, temperature, and thickening agents have a significant impact on the thickness level when added to expressed human milk. Certain foods such as fruit purees, squash, yogurt, and raw oatmeal may effectively thicken human milk, and the IDDSI flow test can assess if the mixture maintains a similar thickness level over time. These foods could be considered for older infants with dysphagia. When thickening human milk for infants with dysphagia, close physician and clinician monitoring is recommended given the potential positive and/or negative consequences on oral feeding and overall health. WHAT IS KNOWN: ⢠Thin liquids can be challenging for infants with dysphagia to safely swallow Human milk is difficult to thicken. WHAT IS NEW: ⢠Pureed fruits and pureed squash thicken human milk effectively at various temperatures and maintain thickness level over 20 minutes. ⢠Pureed fruits and pureed squash thicken human milk effectively at various temperatures and maintain thickness level over 20 Raw oatmeal cereal either thins over time or thickens over time depending on the temperature of the base liquid.
