HIV Prevention Knowledge Base
Biomedical Interventions: Infant Feeding for Mothers Living with HIV
Rapid Assessment of Infant Feeding Support to HIV-positive Women Accessing Prevention of Mother-to-Child Transmission Services in Kenya, Malawi, and Zambia
The authors performed a rapid assessment of HIV and infant feeding practices in Malawi, Kenya, and Zambia, and found serious problems, such as “lack of space and time for proper counseling”; lack of support for nutrition as a preventive measure; few linkages with community-based infant feeding programs; weak monitoring and evaluation; and lack of resources devoted to this activity. They found a “strong bias against breastfeeding” in all three countries, and they cite a United Nations assessment that found that despite training in PMTCT, Kenyan health care workers had “uniformly poor” knowledge of PMTCT. The authors emphasize the need to focus on overall child survival, not just reduction of the risk of HIV transmission.
Intervention to Promote Exclusive Breastfeeding for the First 6 months of Life in a High HIV Prevalence Area
HIV-negative and HIV-positive women in KwaZulu-Natal, South Africa, who received frequent counseling and support to practice exclusive breastfeeding (EBF) were twice as likely to practice EBF as those mothers who did not adhere to regular counseling visits. However, large numbers of mothers did not adhere to the full series of visits. Adherence to EBF at six months was 45 percent of HIV-negative women and 40 percent of women living with HIV. The authors conclude that EBF can be successfully promoted through the provision of a home support program with well-trained lay counselors.
Effect of a Point-of-Use Water Treatment and Safe Water Storage Intervention on Diarrhea in Infants of HIV-Infected Mothers
HIV-exposed infants in Kenya experienced high rates of diarrhea during weaning, according to the Kisumu Breastfeeding Study. Researchers tried to reverse this situation by providing safe water storage vessels, hygiene education, and bleach for household water treatment. The interventions successfully reduced diarrhea before and after weaning, but not during the weaning period itself. Provision of safe water was not found to be protective against weaning-associated diarrhea among infants who were weaned early.
Feasibility of Using Flash-Heated Breastmilk as an Infant Feeding Option for HIV-Exposed, Uninfected Infants after 6 Months of Age in Urban Tanzania
The study explored the feasibility of whether HIV-positive mothers who were breastfeeding could flash-heat (FH) their breast milk for their child to reduce the transmission of HIV. Mothers were visited weekly by a health worker and also had monthly clinic visits. Mothers who were eligible or currently taking antiretrovirals were excluded from the study to better determine the intervention’s effectiveness on the infants. Baseline information on the mothers’ demographics, and infant feeding, growth, and morbidity were collected. Mothers also kept daily journals on infant feeding habits, and health workers measured the peak milk temperatures and collected pre-heated and post-heated milk samples for bacterial cultures. Seventy-two mothers were eligible for the intervention since their infants were HIV-negative, and 51.4 percent (37 mothers) chose to FH their milk once their child turned 6 months. The median duration of FH was 9.6 weeks (range: 1 day-15.6 weeks). Women who expressed more often also expressed a larger amount of breast milk. It was found that mothers were successful in cleaning the utensils, heating the milk, and feeding their infants with the FH milk. About 42 percent of milk samples were found to be contaminated with bacterial growth. Mothers reported little stigma associated with expressing and FH but did report hiding their behaviors about 77 percent of the time, mostly from neighbors and infrequently from friends and family. The study was successful in demonstrating that HIV-positive mothers were both interested and able to express and FH their breast milk to decrease the likelihood that their infants would become infected with HIV.
2010 World Health Organization Guidelines on HIV and Infant Feeding
These World Health Organization guidelines were updated in 2010 in response to significant new programmatic experience and evidence regarding HIV and infant feeding. The 2010 recommendations recognize the important impact of ARVs during the breastfeeding period, and recommend that national authorities in each country decide which infant feeding practice, i.e. breastfeeding with an ARV intervention to reduce transmission or avoidance of all breastfeeding, should be promoted and supported by their Maternal and Child Health services. The document includes the principles, recommendations, and summary of the evidence. Nine key principles focus on overall HIV-free survival; integrated versus vertical infant feeding interventions; setting national strategies for infant feeding; information and counseling for mothers; and promoting breastfeeding among the general population. Seven recommendations are provided on breastfeeding and young child feeding practices.
HIV and Infant Feeding: New Evidence and Programmatic Experience. Report of a Technical Consultation
This report summarizes new findings, conclusions, and recommendations from the World Health Organization HIV and Infant Feeding Technical Consultation held in October 2006. Newer evidence has reversed many of these conclusions.