Rose Bosire1,2, Bourke Betz3, Adam Aluisio4, James P Hughes5, Ruth Nduati6, James Kiarie7,8, Bhavna H Chohan1,9,10, Michele Merkel11, Barbara Lohman-Payne12, Grace John-Stewart3,10,13, Carey Farquhar3,10,13. 1. 1 Kenya Medical Research Institute , Nairobi, Kenya . 2. 2 Karolinska Institutet , Stockholm, Sweden . 3. 3 Department of Epidemiology, University of Washington , Seattle, Washington. 4. 4 Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University , Providence, Rhode Island. 5. 5 Department of Biostatistics, University of Washington , Seattle, Washington. 6. 6 Department of Pediatrics, University of Nairobi , Nairobi, Kenya . 7. 7 Department of Obstetrics, and Gynecology, University of Nairobi , Nairobi, Kenya . 8. 8 Institute of Tropical and Infectious Diseases, University of Nairobi , Nairobi, Kenya . 9. 9 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya . 10. 10 Department of Global Health, University of Washington , Seattle, Washington. 11. 11 Global Scientific Solutions for Health , Baltimore, Maryland. 12. 12 Institute for Immunology and Informatics, University of Rhode Island , Providence, Rhode Island. 13. 13 Department of Medicine, University of Washington , Seattle, Washington.
Abstract
BACKGROUND: Exclusive breastfeeding (EBF) is recommended for 6 months after delivery as the optimal infant feeding method and is especially important for prevention of mother-to-child HIV transmission (PMTCT). However, EBF promotion efforts among HIV-infected mothers in sub-Saharan Africa have achieved mixed success and require context-specific interventions. METHODS: HIV-positive, pregnant women from six clinics in Nairobi were enrolled into a clinic-level, before-after counseling intervention study. All women received standard perinatal and HIV care. Women in the intervention arm were offered three counseling sessions that promoted EBF, described its benefits, and explained breastfeeding techniques. Mother-infant pairs were followed until 14 weeks postpartum, with infant HIV testing at 6 weeks. EBF prevalence at 14 weeks postpartum was compared between study arms using log-binomial regression. Proportions of 6-week HIV-free survival and 14-week infant survival were assessed using Cox regression. Risk estimates were adjusted for clinic, relationship status, and antiretroviral therapy. RESULTS: Between 2009 and 2013, 833 women were enrolled of whom 94% planned to practice EBF for 6 months and 95% were taking therapeutic or prophylactic antiretrovirals. Median age was 27 years; median CD4 count was 403 cells/μL. EBF prevalence at 14 weeks postpartum was 86% in the control and 81% in the intervention group (p = 0.19). No differences were observed between groups for 6-week HIV-free survival and 14-week infant survival. CONCLUSION: Women who received breastfeeding counseling were not more likely to breastfeed exclusively, in part due to high overall EBF prevalence in this study population. The high EBF prevalence is an important finding, given recent efforts to promote EBF in Kenya.
BACKGROUND: Exclusive breastfeeding (EBF) is recommended for 6 months after delivery as the optimal infant feeding method and is especially important for prevention of mother-to-child HIV transmission (PMTCT). However, EBF promotion efforts among HIV-infected mothers in sub-Saharan Africa have achieved mixed success and require context-specific interventions. METHODS: HIV-positive, pregnant women from six clinics in Nairobi were enrolled into a clinic-level, before-after counseling intervention study. All women received standard perinatal and HIV care. Women in the intervention arm were offered three counseling sessions that promoted EBF, described its benefits, and explained breastfeeding techniques. Mother-infant pairs were followed until 14 weeks postpartum, with infant HIV testing at 6 weeks. EBF prevalence at 14 weeks postpartum was compared between study arms using log-binomial regression. Proportions of 6-week HIV-free survival and 14-week infant survival were assessed using Cox regression. Risk estimates were adjusted for clinic, relationship status, and antiretroviral therapy. RESULTS: Between 2009 and 2013, 833 women were enrolled of whom 94% planned to practice EBF for 6 months and 95% were taking therapeutic or prophylactic antiretrovirals. Median age was 27 years; median CD4 count was 403 cells/μL. EBF prevalence at 14 weeks postpartum was 86% in the control and 81% in the intervention group (p = 0.19). No differences were observed between groups for 6-week HIV-free survival and 14-week infant survival. CONCLUSION:Women who received breastfeeding counseling were not more likely to breastfeed exclusively, in part due to high overall EBF prevalence in this study population. The high EBF prevalence is an important finding, given recent efforts to promote EBF in Kenya.
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