Session 4: Group Work (1-5)
Introduction: Linda Sanei, LINKAGES
4:00 - 5:30pm      

TASK:

• Discuss the questions for the group in depth

• Identify first what the group agrees on. Define better where the group possibly disagrees and why and think through the implications of both

• Reach compromise where possible on agreed principles from which possibly an action plan can flow-recognising and planning for adjustments that will be needed as new research results become available

• Prepare a summary report of conclusions, agreements, disagreements and recommendations for action from the group.

• Select 2-3 key outcomes from the group for presentation at the plenary.
  

Group 1: National policies and guidelines
Facilitator: Rene Ekpini, WHO 
Resource Person: Nomajoni Ntombela, LINKAGES/WABA

• Should counselling guidelines for HIV positive mothers include all infant feeding options, some options or only one option (universal guidelines for all HIV positive mothers).

• Should guidelines be universal for all women HIV positive, negative or of unknown status? If yes, under what conditions?

• How could national policies contribute to the normalisation of exclusive breastfeeding (i.e., prevention of stigmatisation)?

• Any research recommendations?

Group 2: Breastmilk substitutes and the Code
Facilitator: Boitshepo Giyose, CRHCS
Resource Person: David Clark, UNICEF

• Are there conditions under which subsidised or free breastmilk substitutes could have a place in PMTCT interventions? If yes, under what conditions?

• What could these breastmilk substitutes be?

• How do we prevent spill over of breastmilk substitutes and messages?

• How do we assess/monitor spill over?

• What is the role of the Code in high HIV prevalence countries?

• What is the argument for providing food of approximately equal value to support the nutritional status of women who choose breastfeeding?

• Any research recommendations?

Group 3: Promoting and supporting breastfeeding in high HIV prevalence 
                countries
Facilitator: Pauline Kisanga, IBFAN
Resource Person: Margaret Kyenkya-Isabirye, UNICEF

• How to sustainably train enough health workers and counsellors on infant and young child feeding in high HIV prevalence countries? How to deal with the lack of breastfeeding management training in currently available training materials?

• Is the baby friendly hospital initiative (BFHI) still relevant in high HIV-prevalence countries? Any recommendations?

• What do we need to do to strengthen and expand BFHI and training? (who, what, how?)

• Any research recommendations?

Group 4: Supporting HIV positive mothers with infant feeding 

Facilitator: Pamela Morrison, WABA and Peter Iliff
Resource Person: Ellen Piwoz, SARA

• What do we need to do to improve evidence-based risk assessment and counselling within PMTCT programmes, and who is responsible for doing it?

• What evidence exists to suggest that rapid cessation after six months of exclusive breastfeeding would reduce MTCT? Discuss risk-benefit ratio of early cessation vs continued partial breastfeeding. Give conditions for safe/early/abrupt cessation of breastfeeding, e.g. how do you stop a child from breastfeeding and how/what to feed a child during the process of cessation and after cessation?"

• What do we know about continued breastfeeding-should it be among the infant feeding options for HIV positive mothers? If yes, under what conditions?

• Any research recommendations?

Group 5: Research, monitoring and evaluation
Facilitator: Meera Shekar, UNICEF
Resource Person: Nigel Rollins, University of Natal, South Africa

• In conditions of normal maternal and child health service settings in developing countries, what can we realistically expect in terms of monitoring and evaluation?

• How can gaps be filled? Could a request for proposal type of system be established to meet research gaps linked to capacity constraints?

• Review the WHO list of on-going research and research plans and identify possible gaps.

• Can anything be done about the fact that the interface between research and changes in PMTCT policy and programme planning seems to be based on conference presentations that are not yet peer reviewed and are
  difficult for most to obtain?

• What can WABA members and others do to contribute to implementation of the research agenda?

• All other major foods have special CGIAR and other research and policy institutes. Is it time to consider the need for an International Breastfeeding Policy, Research and Training Institute that could assist with such tasks?

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