[MoPeD3683] Low adherence to recommended infant feeding strategies in the pilot phase of a randomized trial to prevent mother-to-child HIV transmission in rural Botswana

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Low adherence to recommended infant feeding strategies in the pilot phase of a randomized trial to prevent mother-to-child HIV transmission in rural Botswana

[AUTHOR(S):] R.L. Shapiro, S. Lockman, I. Thior, L. Stocking, P. Kebaabetswe, C. Wester, T. Peter, R. Marlink, M. Essex, S.J. Heymann¹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoPeD3683

BACKGROUND: Both exclusive breastfeeding and formula feeding have been recommended to prevent mother-to-child HIV transmission (MTCT) among infants born to HIV-infected women. The Botswana government recommends formula feeding, but little is known about the ability of women to exclusively adhere to either strategy.

METHODS: We conducted a pilot study in rural Botswana to determine the feasibility of two infant feeding strategies believed to have equivalent potential to reduce MTCT. Between April 2000 and March 2001, 75 women randomized to either formula feed their infants or to breastfeed their infants while providing daily prophylactic zidovudine to uninfected infants. Women were counseled at monthly visits to exclusively follow their designated strategy.

RESULTS: Analysis of preliminary data revealed that 31% of 36 women in the breastfeeding arm exclusively breastfed their infants in the first 5 months of life. Having more than one child was associated with mixed feeding (p < 0.05). Only 14% of 39 women in the formula feeding arm reported any breastfeeding, but 61% had evidence of breast milk on physical exam in at least 2 postpartum visits between 2 and 6 months. Among women in the formula feeding arm, higher viral loads were associated with the lack of breast milk on exam (p < 0.05).

CONCLUSIONS: Exclusive adherence to assigned feeding strategy was difficult to achieve among randomized women in this pilot study, despite counseling at each visit. Women with higher viral loads, who are more likely to transmit HIV, appeared less likely to breastfeed when assigned to the formula feeding arm than those with lower viral loads. This finding may reflect the choices of potentially more symptomatic mothers, or may predict decreased ability to breastfeed or to produce breast milk. Low adherence to recommended feeding strategies needs to be considered when implementing infant feeding programs in the developing world.

Presenting author: Roger Shapiro

1Botswana-Harvard Partnership, Harvard School of Public Health, Dept of Immunology and Infectious Diseases, 651 Huntington Ave FXB 401, Boston, MA 02115, Botswana.

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