ZVITAMBO: Zimbabwe Vitamin A for Mothers and Babies Project

ZVITAMBO used a randomized, controlled clinical trial among 14,110 mother-infant pairs. The study determined the impact of administering single oral doses of vitamin A to mothers and neonates in the immediate postpartum period on several outcomes, including infant mortality, mother-to-child HIV transmission during breastfeeding, and maternal HIV infection during the postpartum year. 

Enrollment for the study was conducted from 1997 to 2000, and all field work was completed in May 2001. Several laboratory and data analyses have been completed and the work continues. In April 2006, additional funds from the USAID Office on HIV/AIDS supported pilot work on the feasibility of early breastfeeding cessation and potential replacement feeding alternatives for rural HIV-positive women. 

ZVITAMBO is a collaborative study between the University of Zimbabwe, the Harare City Health Department, the Montreal General Hospital Research Institute and JHSPH. In addition to the funding received from USAID via the GRA, ZVITAMBO is supportd by the Candian International Development Agency, the Bill and Melinda Gates Foundation, Rockefeller Foundation, and BASF (Ludwigshafen, Germany). 

Substudies were suppported by the Support for Analysis and Research in Africa (SARA), Linkages projects (Academy for Educational Development), Nestle Foundation, and the Pediatric AIDS Foundation.

Principal Investigator:  Jean Humphrey (JHSPH)

Investigators:

• Partson Zvandasara (The University of Zimbabwe, College of Health Sciences, Department of Obstetrics and Gynaecology)
• Peter J. Iliff (ZVITAMBO Project, Harare, Zimbabwe)
• Kuda Mutasa (ZVITAMBO Project, Harare, Zimbabwe)
• Henry Chidawanyika (ZVITAMBO Project, Harare, Zimbabwe)
• John Hargrove (SACEM, Stellenbosch University, South Africa)
• Lawrence Moulton (JHSPH)
• Lucie Malaba (The University of Zimbabwe, Institute of Nutrition and Family Sciences)
• Kusum Nathoo (The University of Zimbabwe, College of Health Sciences, Paediatrics and Child Health)
• Lynn Zijenah (The University of Zimbabwe, College of Health Sciences, Department of Immunology)
• Michael Mbizvo (WHO, Geneva, Switzerland)
• Brian Ward (The Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada)
• Ellen Piwoz (SARA Project, Academy for Educational Development, Washington, DC)
• Robert Ntozini (ZVITAMBO Project, Harare, Zimbabwe)
• Edmore Marinda (School of Public Health, Witswatersland Medical School University, South Africa)
• Agnes Mahomva (Ministry of Health and Child Welfare, Government of Zimbabwe)
• Florence Majo (ZVITAMBO Project, Harare, Zimbabwe)
• Mary Ndhlovu (ZVITAMBO Project, Harare, Zimbabwe)
• Clare D. Zunguza (City Health Department, Harare, Zimbabwe)
• Faith Mzengeza (ZVITAMBO Project, Harare, Zimbabwe)
• Naume V. Tavengwa (ZVITAMBO Project, Harare, Zimbabwe)
• Phillipa M.Rambanepasi (ZVITAMBO Project, Harare, Zimbabwe)

Publications:

Humphrey JH, Hargrove JW, Iliff PJ, Zvandasara P, Moulton LH,Mutasa K, Ntozini R, Malaba LC, , Zijenah LS, Ward BJ, the ZVITAMBO Study Group, and Humphrey JH. (2007). HIV-1 and HIV-2 prevalence and associated risk factors among postnatal women in Harare, Zimbabwe. Epidemiology and Infection, 12, 1-10.

Humphrey JH, Hargrove JW, Malaba LC, Iliff PJ, Moulton LH, Mutasa K, Zvandasara P, Nathoo KJ, Mzengeza F, Chidawanyika H, Zijenah LS, Ward BJ; ZVITAMBO Study Group. (2006) HIV incidence among post-partum women in Zimbabwe: Risk factors and the effect of vitamin A supplementation. AIDS, 20, 10, 1437-46.

Humphrey JH and Ichord RN. (2001). Safety of vitamin A supplementation of postpartum women and young children.  Food and Nutrition Bulletin, 22,  311-319.

Humphrey JH and Iliff PJ. (2001). Is breast not best?  Feeding infants born to HIV positive mothers: bringing balance to a complex issue. Nutrition Reviews, 59, 119-127.

Humphrey JH, Iliff PJ, Marinda ET, Mutasa K, Moulton LH, Chidawanyika H, Ward BJ, Nathoo KJ, Malaba LC, Zijenah LS, Zvandasara P, Ntozini R, Mzengeza F, Mahomva AI, Ruff AJ, Mbizvo MT, Zunguza CD; ZVITAMBO Study Group. Effects of a single large dose of vitamin A, given during the postpartum period to HIV-positive women and their infants, on child HIV infection, HIV-free survival, and mortality. J of Infect Dis. 2006 Mar 15;193(6):860-71.

Humphrey JH, Rice AL. Vitamin A Supplementation in Young Infants. Lancet. 2000, Jul 29;356(9227):422-24.

Iliff PJ, et al. Early exclusive breastfeeding reduces the risk of postnatal HIV-1 transmission and increases HIV-free survival. AIDS. 2005;19:699-708.

Iliff PJ, Humphrey JH, Mahomva AI, Zvandasara P, Bonduelle M, Malaba LC, Nathoo KJ.  Tolerance of large doses of vitamin A given to mothers and their babies shortly after delivery.  Nutr Res 1999; 19 (10): 1437-1446.

Lajoie J, et al. Novel TAP1 polymorphisms in indigenous Zimbabweans: Their implications of TAP function and in human diseases. Hum Immun. 2003 Aug;64(8):733-40.

Lajoie J, et al. New TAP2 polymorphisms in the Shona people of Zimbabwe. Human Immunology. 2003 Jul;64(7):733-40.

Lajoie J, Hargrove JW, Zijenah LS, Humphrey JH, Ward BJ, Roger M. (2006). Genetic variants in non-classical MHC class I HLA-E and HLA-G molecules are associated with risk of heterosexual HIV-1 infection. J Infectious Diseases, 193, 298-301.

Malaba LC, et al. Effect of postpartum maternal or neonatal vitamin A supplementation on infant mortality among infants born to HIV-negative mothers in Zimbabwe. Am J Clin Nutr. 2005 Feb;81(2):454-60.

Matte C, et al. Mother-to-child HLA-G concordance: No impact on the risk of mother to child transmission of HIV-1. AIDS 2002;16:2491-94.

Matte C, et al. HLA-G and HLA-E polymorphisms in an indigenous African population. Hum Immun. 2000 November;61 (11):1150-6.

Matte C., Lacaille J., Zijenah L., Ward B., ZVITAMBO Study Group and Roger M. (2002). HLA-G exhibits low level of polymorphism in indigenous East Africans. Human Immunology, 63, 6, 495-501.

Miller M, et al. Why do children become vitamin A deficient? J Nutr. 2002 Sept;132(9 supp):2867-80S.

Miller MF, Humphrey JH, Iliff PJ, Malaba LC, Mbuya NV, Stoltzfus RJ; ZVITAMBO Study Group. Neonatal erythropoiesis and subsequent anemia in HIV-positive and HIV-negative Zimbabwean babies during the first year of life: A longitudinal study. BMC Infect Dis. 2006 Jan 3;6:1.

Miller M, Iliff P, Stoltzfus RJ, Humphrey J. (2002). Breastmilk erythropoietin and mother to child HIV transmission through breastmilk. Lancet, 360, 1246-1248.

Miller MF, Stoltzfus RJ, Iliff PJ, Malaba LC, Mbuya NV; Zimbabwe Vitamin A for Mothers and Babies Project (ZVITAMBO) Study Group, Humphrey JH. Effect of maternal and neonatal vitamin A supplementation and other postnatal factors on anemia in Zimbabwean infants: a prospective, randomized study. Am J of Clin Nutr. July 2006;84(1):212-22.

Miller MF, Stoltzfus RJ, Mbuya NV, Malaba LC, Iliff PJ, Humphrey JH; ZVITAMBO Study Group Total body iron in HIV-positive and HIV-negative Zimbabwean newborns strongly predicts anemia throughout infancy and is predicted by maternal hemoglobin concentration. J Nutr. 2003;133(11):3461-8.

Piwoz EG, Humphrety JH, Marinda ET, Mutasa K, Moulton LH, Iliff PJ for the ZVITAMBO Study Group. (2006). Effects of infant gender on mother-to-child transmission of HIV-1 according to timing of infection in Zimbabwe. AIDS, 20, 15, 1981-4.

Piwoz EG, Iliff PJ, Tavengwa N, Gavin L, Marinda E, Lunney K, Zunguza C, Nathoo KJ, Humphrey JH.An education and counseling program for preventing breast-feeding-associated HIV transmission in Zimbabwe: Design and impact on maternal knowledge and behavior. J Nutr. 2005 Apr. 135(4):950-5.

Piwoz EG, Ross J, Humphrey J. (2004). Human immunodeficiency virus transmission during breastfeeding: knowledge, gaps, and challenges for the future.  Adv Exp Med Biol, 554, 195-210.

Rollins N, Meda N, Becquet R, Coutsoudis A, Humphrey J, Jeffrey B, Kanshana A, Kuhn L, Leroy V, Mbori-Ngacha D, McIntyre J, Newell ML, for the Ghent IAS Working Group on HIV in Women and Children. (2004). Preventing postnatal transmission for HIV-1 through breastfeeding:  modifying infant feeding practices. JAIDS, 35, 2, 188-195.

Stoltzfus RJ, Humphrey JH.  Vitamin A and the nursing mother-infant dyad: Evidence for intervention. Adv Exp Med Biol. 2002;503:39-47.

Tavengwa NV, Piwoz EG, Iliff PJ, Marinda ET, Moulton LH, Zunguza CD, Nathoo KJ, the ZVITAMBO Study Group, and Humphrey JH. (2007). Adoption of safer infant feeding and postpartum sexual practices and their relationship to maternal HIV status and risk of acquiring HIV in Zimbabwe. Tropcial Med and International Health, 12, 1, 97-106.

Zijenah LS, Humphrey J, Nathoo K, Malaba L, Zvandasara P, Mahomva A, Iliff P, Mbizvo MT. Evaluation of the prototype Roche DNA amplification kit incorporating the new SSK145 and SKCC1B primers in detection of Human Immunodeficiency Virus Type 1 DNA in Zimbabwe.  J Clin Microbiol. 1999 Nov; 37(11):3569-71.

Zijenah LS, Moulton LH, Iliff P, Nathoo K, Munjoma MW, Mutasa K, Malaba L, Zvandasara P, Ward BJ, Humphrey J; ZVITAMBO Study Group. Timing of mother-to-child transmission of HIV-1 and infant mortality in the first six months of life in Harare, Zimbabwe. AIDS. 2004 Jan 3;18(2):273-80.

Zvandasara P, Hargrove JW, Ntozini R, Chidawanyika H, Iliff PJ, Moulton LH, Mutasa K, Mzengeza F, Malaba LC, Nathoo KJ, Zijenah LS, Mbizvo M, Ward BJ, ZVITAMBO Study Group, and Humphrey JH. (2006). Mortality and morbidity among postpartum HIV-positive and HIV-negative women in Zimbabwe: risk factors, causes, and impact of single-dose postpartum vitamin A supplementation. JAIDS, 43, 1, 107-16.

Additional manuscripts in press

Piwoz EG, et al. Promotion of safer breastfeeding practices in an area of high HIV-prevalence reduces postnatal HIV transmission and increases HIV-free survival in infants born to mothers of unknown HIV status (AJPH).