by Sarah Kasleder for SHRF
“What if we can provide the benefits of breastmilk to babies born to HIV-positive mothers without the risk of transmission?” asks Dr. Kelsey Cochrane.
Kelsey and her dedicated team have recently learned that they will receive the SHRF 2024 Excellence Award for the 2023-24 Solutions Innovation Grant at the SHRF Annual Santé Awards. This project, co-funded by the Jim Pattison Children’s Hospital Foundation (JPCHF), is leading a study focused on the acceptability and feasibility of providing donor breastmilk to babies born to individuals living with HIV. They are exploring whether donor breastmilk could offer a valuable alternative to formula feeding, which experts currently recommend to prevent the transmission of HIV through breastfeeding.
“We’re not just talking about feeding babies; we’re talking about potentially changing how we approach infant health for some of our most vulnerable populations,” Cochrane emphasizes.
The Importance of Breastmilk for Immunity and Development
Experts recognize breastmilk for its unparalleled nutritional and immunological benefits. According to Cochrane, “Both breastmilk and formula provide the nutrition needed to keep a baby alive. However, the nutrition you get from breastmilk is easier for the baby to tolerate and digest.” She explains that breastmilk contains “bioactive components that help build the immune system, support brain development, and provide long-term health benefits.” These are components that cannot be replicated in formula, highlighting the unique advantages of breastmilk for infant health and the importance of this research in harnessing these benefits.
For babies born to HIV-positive individuals, who may be more susceptible to infections due to weakened immune systems, these benefits are even more critical. “Even if HIV is not transmitted to baby, being HIV-exposed may still affect their overall immune system, and they are still considered immunocompromised,” Cochrane points out. “Providing donor milk to this population, especially those exclusively getting infant formula, could really benefit these babies.”
Addressing the HIV Epidemic in Saskatchewan
Saskatchewan faces an HIV epidemic, with rates five times higher than our national average. Given the high prevalence of HIV in the province, Cochrane’s research is particularly relevant. “Before returning to Saskatchewan, I spent time in San Diego at the Human Milk Institute, which opened my eyes to the incredible potential of human milk,” Cochrane shares. “As I was coming back to Saskatchewan, I felt excited about working on issues prominent in our province. The high rates of HIV in Saskatchewan made it clear that this was an issue that needed urgent attention.” Her research seeks to address a significant gap in infant feeding guidelines for HIV-exposed babies—specifically, the lack of support for using donor breastmilk as an alternative to formula. “There’s a clear need for more options that prioritize the health and well-being of these vulnerable infants,” Cochrane states, “Donor breastmilk could be a game-changer, but we need the research to back it up.”
Potential Benefits for Mothers
In addition to benefiting the infants, Cochrane’s research explores how providing donor breastmilk could positively impact the mothers. For women living with HIV, the inability to breastfeed can be emotionally challenging, especially when they are aware of the benefits of breastfeeding. “There is so much pressure on mothers to breastfeed their babies, and being told it is recommended to not may be difficult for a mother,” Cochrane explains. By offering donor breastmilk as an option, this research could help alleviate some of the emotional strain, providing mothers with a sense of participation in their baby's nutrition and potentially improving maternal mental health during the postpartum period. This aspect of the research underscores the potential benefits for mothers and the importance of considering their well-being in infant feeding practices.
A Two-Phase Study to Explore Feasibility and Acceptability
Cochrane structured her study into two phases. In the first phase, she plans to engage HIV-positive individuals who are currently pregnant or have recently given birth. These discussions, organized as sharing circles and focus groups in partnership with Indigenous research groups, are essential for gathering initial data and insights. Sharing circles to investigate the acceptability of donor milk are being facilitated in collaboration with Pewaseskwan, an Indigenous Wellness Research Group focused on Indigenous health and wellness, and Waniska, an Indigenous-led center for research on HIV, Hepatitis C, and other sexually transmitted and blood-borne infections (STBBI). The collaboration also includes co-investigators Dr. Alexandra King, Saydi Harlton, Sarah Crawford, Chelsie Collins, and Dakota (Koda) Sinclair. Cochrane and her team will examine whether there is a need for more knowledge translation efforts to ensure caregivers are informed about the benefits and processes involved with donor breast milk.
“These sharing circles are not just about collecting data—they’re about building trust and understanding within the community,” Cochrane explains. “By collaborating with Indigenous research partners, we’re ensuring that the voices of those most affected are heard and respected throughout this process.” The choice to partner with Indigenous groups is essential because a significant portion of the HIV-positive population in Saskatchewan self-identifies as Indigenous. “Engaging with Indigenous communities is crucial, given that they represent a large part of those affected by HIV in our province,” Cochrane adds.
The second phase will focus on the clinical feasibility of providing donor breastmilk to a small group of HIV-positive individuals in Saskatoon. In collaboration with infectious disease pediatrician Dr. Rupeena Purewal and with support from the Saskatchewan Health Authority for the recruitment of participants, this phase will assess the logistics of getting the donor breast milk from the milk bank located in Calgary, delivering and utilizing donor milk, the challenges caregivers might face, and the potential benefits for infants. “This phase is about understanding the real-world challenges and opportunities of implementing donor milk in this context,” Cochrane explains. Her team will also explore the potential benefits on the infants’ microbiome, which could have positive long-term health implications. “The insights we gain here will be crucial in shaping the future of infant feeding practices for HIV-exposed babies,” she adds.
Overcoming Challenges and Looking Ahead
Cochrane and her team anticipate several challenges, particularly in the study's second phase, where they will closely examine logistical issues such as milk storage and handling. In the first phase, the team may also uncover a need for increased knowledge translation activities or education as they assess caregivers' understanding and perceptions of donor breast milk. “Understanding how familiar caregivers are with donor breastmilk and addressing any gaps in knowledge will be crucial,” Cochrane notes, underscoring the importance of these insights for the project's success.
However, she remains optimistic, thanks to the strong support from her research partners and the broader specific scientific community in Saskatchewan. “I feel supported by the scientific community here, and I’m optimistic about the potential impact of this research,” she says.
Ultimately, Cochrane’s work aims to expand infant feeding options for HIV-exposed babies and improve access to donor breastmilk. By addressing the unique needs of this vulnerable population, her research could pave the way for new guidelines and health policies that support the well-being of babies and their caregivers.
A Collaborative Effort with a Passionate Team
Cochrane is quick to acknowledge the collaborative nature of her project. "I am so thankful to the research partners on this project. I could not have gotten this grant without them," she says, emphasizing the critical role of her team in making this research possible. This collaboration extends beyond the academic community, as Cochrane has also engaged with government officials and the Ministry of Health to discuss the potential of scaling up this initiative.
As this research progresses, it holds the promise of not only improving health outcomes for HIV-exposed babies in Saskatchewan but also contributing to a broader understanding of the role donor breastmilk can play in supporting infant health.
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