Impact of Counseling on Breastfeeding Practice and Perinatal HIV-1 Transmission in Nairobi, Kenya
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Background: Breastfeeding is associated with significant reductions in infant mortality rates in developing country settings, and the World Health Organization recommends exclusive breastfeeding (EBF) for 6 months when possible. Where HIV-infected mothers receive anti-retroviral treatment (ART), it is recommended that they also practice EBF. However, exclusive breastfeeding rates remain low throughout sub-Saharan Africa, irrespective of maternal HIV status. Counseling interventions have been demonstrated to increase EBF rates in a variety of settings, but few studies have designed and evaluated interventions for HIV-infected women in sub-Saharan Africa. Methods: HIV-positive pregnant women reporting for care at six government health facilities in Nairobi were enrolled into a before-after study. The first cohort of women at each clinic received standard perinatal care and the second group was offered standard care plus three sessions of lactation counseling sessions promoting exclusive breastfeeding for prevention of mother-to-child HIV-1 transmission (PMTCT). Subjects were followed until 14 weeks after delivery, and infants were tested for HIV at six weeks postpartum. The proportion of women practicing EBF at fourteen weeks postpartum was compared between control and intervention groups using binomial regression. Other outcomes included 6-week HIV-free survival, 14-week infant survival, and counts of breast pathology from 0 to 14 weeks postpartum. Results: Eight hundred thirty-three women were enrolled into the study between 2009 and 2013. Median age was 27 years (Interquartile range [IQR] 23-31 yeas), and median CD4 count was 403 cells/μL (IQR 287-571). The proportion of women practicing EBF at 14 weeks postpartum was high in both groups (>80%) and there was no significant difference between treatment and control group (p>0.05). No differences were observed between groups for 6-week HIV-free survival, 14-week infant survival, or prevalence of breast pathology. Conclusion: The counseling intervention was not associated with increased EBF. However, the proportion of women practicing EBF, irrespective of study arm, was nearly two times higher than the proportion reported nationally in 2008. High rates of EBF in the study population may be attributable to policy changes and a strong national PMTCT program.
- Epidemiology