Anthony Ogwu1,2,3, Sikhulile Moyo1,4, Kathleen Powis1,2, Aida Asmelash1,2, Shahin Lockman1,2,5, Claire Moffat1,6, Jean Leidner7, Joseph Makhema1,2, Max Essex1,2, Roger Shapiro1,2,8. 1. Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana. 2. Harvard T.H. Chan School of Public Health, Boston, MA, USA. 3. Trinity Medical Centre, Piccadilly, WA, Australia. 4. Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa. 5. Brigham and Women's Hospital, Boston, MA, USA. 6. Greater Manchester West Mental Health NHS Foundation Trust, Prestwich, UK. 7. Goodtables Data Consulting, Norman, OK, USA. 8. Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abstract
OBJECTIVE:Infants born to HIV-infected women receivingantiretroviral treatment (ART) can be breastfed through at least 6 months with very low risk of HIV acquisition. We aimed to identify demographic and cultural factors that may influence mothers' willingness to breastfeed for the recommended duration. METHODS: We evaluated factors associated with early cessation of breastfeeding (i.e. before 5 months post-partum) in a randomized clinical trial evaluating different ART regimens used for prevention of mother-to-child transmission during breastfeeding in Botswana. Univariate and multivariable Cox regressions were used to describe predictors of early exclusive BF cessation. RESULTS: Among 677 women who started breastfeeding, the median time to breastfeeding cessation was 178 days (IQR 150-181) and 25.1% weaned early. In multivariable analysis, urban location (aHR = 1.86 95%CI 1.27-2.73; P = 0.002), salaried employment or being a student (aHR = 2.78 95% CI 1.63-4.75; P < 0.001) and infant hospitalisation before weaning (aHR = 2.04 95% CI 1.21-3.45; P = 0.008) were independently and significantly associated with early BF cessation. CONCLUSIONS: Improved support for breastfeeding among employed mothers, especially in urban settings, may allow HIV-infected women who are receiving ART prophylaxis to breastfeed longer.
RCT Entities:
OBJECTIVE:Infants born to HIV-infectedwomen receiving antiretroviral treatment (ART) can be breastfed through at least 6 months with very low risk of HIV acquisition. We aimed to identify demographic and cultural factors that may influence mothers' willingness to breastfeed for the recommended duration. METHODS: We evaluated factors associated with early cessation of breastfeeding (i.e. before 5 months post-partum) in a randomized clinical trial evaluating different ART regimens used for prevention of mother-to-child transmission during breastfeeding in Botswana. Univariate and multivariable Cox regressions were used to describe predictors of early exclusive BF cessation. RESULTS: Among 677 women who started breastfeeding, the median time to breastfeeding cessation was 178 days (IQR 150-181) and 25.1% weaned early. In multivariable analysis, urban location (aHR = 1.86 95%CI 1.27-2.73; P = 0.002), salaried employment or being a student (aHR = 2.78 95% CI 1.63-4.75; P < 0.001) and infant hospitalisation before weaning (aHR = 2.04 95% CI 1.21-3.45; P = 0.008) were independently and significantly associated with early BF cessation. CONCLUSIONS: Improved support for breastfeeding among employed mothers, especially in urban settings, may allow HIV-infectedwomen who are receiving ART prophylaxis to breastfeed longer.
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