NDLI: Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana

Content Provider	Springer Nature : BioMed Central
Author	Mayondi, Gloria Katuta Mussa, Aamirah Zash, Rebecca Moyo, Sikhulile Issacson, Arielle Diseko, Modiegi Mabuta, Judith Mogomotsi, Goabaone Dintwa, Eldah Makhema, Joseph Mmalane, Mompati Lockman, Shahin Morroni, Chelsea Shapiro, Roger
Abstract	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.
Related Links	https://internationalbreastfeedingjournal.biomedcentral.com/counter/pdf/10.1186/s13006-021-00424-x.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	17464358
DOI	10.1186/s13006-021-00424-x
Journal	International Breastfeeding Journal
Issue Number	1
Volume Number	16
Language	English
Publisher	BioMed Central
Publisher Date	2021-10-13
Access Restriction	Open
Subject Keyword	Maternal and Child Health HIV Infant feeding Women living with HIV Breastfeeding Viral load Botswana
Content Type	Text
Resource Type	Article
Subject	Obstetrics and Gynecology Pediatrics, Perinatology and Child Health
Journal Impact Factor	2.9/2023
5-Year Journal Impact Factor	3.6/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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