Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana.
Botswana
Breastfeeding
HIV
Infant feeding
Viral load
Women living with HIV
Journal
International breastfeeding journal
ISSN: 1746-4358
Titre abrégé: Int Breastfeed J
Pays: England
ID NLM: 101251562
Informations de publication
Date de publication:
13 10 2021
13 10 2021
Historique:
received:
30
03
2021
accepted:
21
09
2021
entrez:
14
10
2021
pubmed:
15
10
2021
medline:
9
11
2021
Statut:
epublish
Résumé
Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy. From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice. Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy. In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.
Sections du résumé
BACKGROUND
Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy.
METHODS
From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice.
RESULTS
Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy.
CONCLUSIONS
In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.
Identifiants
pubmed: 34645461
doi: 10.1186/s13006-021-00424-x
pii: 10.1186/s13006-021-00424-x
pmc: PMC8513305
doi:
Substances chimiques
RNA, Viral
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
81Subventions
Organisme : NICHD NIH HHS
ID : R01 HD095766
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI131928
Pays : United States
Organisme : NICHD NIH HHS
ID : R01 HD080471
Pays : United States
Organisme : FIC NIH HHS
ID : D43 TW009610
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI131924
Pays : United States
Informations de copyright
© 2021. The Author(s).
Références
JAMA Pediatr. 2017 Oct 2;171(10):e172222
pubmed: 28783807
Lancet HIV. 2016 May;3(5):e221-30
pubmed: 27126489
Int Breastfeed J. 2017 Jul 12;12:31
pubmed: 28717383
AIDS. 2013 Jul 31;27(12):1911-20
pubmed: 24180000
BMC Pediatr. 2016 Jul 21;16:103
pubmed: 27439303
PLoS One. 2019 Jan 16;14(1):e0210782
pubmed: 30650156
J Int AIDS Soc. 2018 Apr;21(4):e25107
pubmed: 29667336
J Pediatr. 2018 Dec;203:68-75.e2
pubmed: 30318370
Int Breastfeed J. 2018 Jun 7;13:20
pubmed: 29930693
Lancet Glob Health. 2017 May;5(5):e491-e500
pubmed: 28395844
BMJ Open. 2013 Nov 29;3(11):e003749
pubmed: 24293206
Int Breastfeed J. 2019 Jan 31;14:7
pubmed: 30733819