Recorded presentation

Ruth Nduati, MD¹, Dorothy Mbori-Ngacha, MBChB, MMed, MPH², Naomi Rutenberg, PhD³, and Scott Geibel, MPH³. (1) Network for AIDS Research in East and Southern Africa (NARESA), P.O. Box 21361, Nairobi, Kenya, (2) Centers for Disease Control and Prevention, Kenya (CDC Kenya), PMTCT Section, Global AIDS Program, P.O. Box 30137, Nairobi, Kenya, (3) Horizons, Population Council, 4301 Connecticut Ave, NW Suite 280, Washington, DC 20008, (202)237-9405, nrutenberg@pcdc.org

Background

“Breast is best” yet more than one-third of HIV transmission to infants occurs through breastfeeding where extended breastfeeding is the norm. In pilot PMTCT sites in Kenya, women who received a negative HIV test result or of unknown status were recommended to breastfeed their infant exclusively. Women who received a positive result were informed about the risks of breast milk transmission of HIV and counseled on three choices: exclusive breastfeeding, replacement feeding with formula, and replacement feeding with modified cow’s milk.

Methods

Researchers compared the infant feeding practices for six-week-old infants, based on a 24-hour recall, of HIV-positive and HIV-negative mothers who received PMTCT services in 2000-2002 at district hospitals in Karatina (n=588) and Homa Bay (n=380).

Results

In Homa Bay, only 28% of HIV-, 22% of HIV+, and 25% of unknown status women exclusively breastfed their infants. The comparable figures for Karatina were 29%, 15% and 24%. Mixed feeding was common in Homa Bay; 71% and 64% of HIV- and HIV+ women practiced mixed feeding for six-week-old infants. A small percentage of HIV-positive women in either site chose formula, despite the availability of free supplies. In Karatina, 43% of HIV-positive women used local foods to completely replace breast milk.

Conclusions

Infant feeding practice of women who attended PMTCT sites is far from optimal for preventing HIV transmission or improving child health. PMTCT providers should extend infant feeding counseling into the postpartum period when women decide how to feed their infants and grapple with the implementation of their choices.

Learning Objectives:

• 1. Quantify the importance of breastmilk transmission to HIV infection in young infants.
• 2. Identify the recommended infant feeding strategies to reduce HIV transmission through breastfeeding.
• 3. Recognize the magnitude of the challenge of addressing breastmilk transmission in PMTCT programs in low resource settings.

Keywords: HIV Interventions, Infant Health

Related Web page: www.populationcouncil.com/pdfs/horizons/rs/re_mtctc.pdf

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation