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High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women.
Breastfeed Med 2016; 11(2):56-63BM

Abstract

BACKGROUND

Exclusive breastfeeding (EBF) is recommended for 6 months after delivery as the optimal infant feeding method and is especially important for prevention of mother-to-child HIV transmission (PMTCT). However, EBF promotion efforts among HIV-infected mothers in sub-Saharan Africa have achieved mixed success and require context-specific interventions.

METHODS

HIV-positive, pregnant women from six clinics in Nairobi were enrolled into a clinic-level, before-after counseling intervention study. All women received standard perinatal and HIV care. Women in the intervention arm were offered three counseling sessions that promoted EBF, described its benefits, and explained breastfeeding techniques. Mother-infant pairs were followed until 14 weeks postpartum, with infant HIV testing at 6 weeks. EBF prevalence at 14 weeks postpartum was compared between study arms using log-binomial regression. Proportions of 6-week HIV-free survival and 14-week infant survival were assessed using Cox regression. Risk estimates were adjusted for clinic, relationship status, and antiretroviral therapy.

RESULTS

Between 2009 and 2013, 833 women were enrolled of whom 94% planned to practice EBF for 6 months and 95% were taking therapeutic or prophylactic antiretrovirals. Median age was 27 years; median CD4 count was 403 cells/μL. EBF prevalence at 14 weeks postpartum was 86% in the control and 81% in the intervention group (p = 0.19). No differences were observed between groups for 6-week HIV-free survival and 14-week infant survival.

CONCLUSION

Women who received breastfeeding counseling were not more likely to breastfeed exclusively, in part due to high overall EBF prevalence in this study population. The high EBF prevalence is an important finding, given recent efforts to promote EBF in Kenya.

Authors+Show Affiliations

1 Kenya Medical Research Institute , Nairobi, Kenya . 2 Karolinska Institutet , Stockholm, Sweden .3 Department of Epidemiology, University of Washington , Seattle, Washington.4 Department of Emergency Medicine, Warren Alpert School of Medicine, Brown University , Providence, Rhode Island.5 Department of Biostatistics, University of Washington , Seattle, Washington.6 Department of Pediatrics, University of Nairobi , Nairobi, Kenya .7 Department of Obstetrics, and Gynecology, University of Nairobi , Nairobi, Kenya . 8 Institute of Tropical and Infectious Diseases, University of Nairobi , Nairobi, Kenya .1 Kenya Medical Research Institute , Nairobi, Kenya . 9 Department of Medical Microbiology, University of Nairobi , Nairobi, Kenya . 10 Department of Global Health, University of Washington , Seattle, Washington.11 Global Scientific Solutions for Health , Baltimore, Maryland.12 Institute for Immunology and Informatics, University of Rhode Island , Providence, Rhode Island.3 Department of Epidemiology, University of Washington , Seattle, Washington. 10 Department of Global Health, University of Washington , Seattle, Washington. 13 Department of Medicine, University of Washington , Seattle, Washington.3 Department of Epidemiology, University of Washington , Seattle, Washington. 10 Department of Global Health, University of Washington , Seattle, Washington. 13 Department of Medicine, University of Washington , Seattle, Washington.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26885769

Citation

Bosire, Rose, et al. "High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women." Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine, vol. 11, no. 2, 2016, pp. 56-63.
Bosire R, Betz B, Aluisio A, et al. High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women. Breastfeed Med. 2016;11(2):56-63.
Bosire, R., Betz, B., Aluisio, A., Hughes, J. P., Nduati, R., Kiarie, J., ... Farquhar, C. (2016). High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women. Breastfeeding Medicine : the Official Journal of the Academy of Breastfeeding Medicine, 11(2), pp. 56-63. doi:10.1089/bfm.2015.0071.
Bosire R, et al. High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women. Breastfeed Med. 2016;11(2):56-63. PubMed PMID: 26885769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High Rates of Exclusive Breastfeeding in Both Arms of a Peer Counseling Study Promoting EBF Among HIV-Infected Kenyan Women. AU - Bosire,Rose, AU - Betz,Bourke, AU - Aluisio,Adam, AU - Hughes,James P, AU - Nduati,Ruth, AU - Kiarie,James, AU - Chohan,Bhavna H, AU - Merkel,Michele, AU - Lohman-Payne,Barbara, AU - John-Stewart,Grace, AU - Farquhar,Carey, Y1 - 2016/02/17/ PY - 2017/03/01/pmc-release PY - 2016/2/18/entrez PY - 2016/2/18/pubmed PY - 2016/12/29/medline SP - 56 EP - 63 JF - Breastfeeding medicine : the official journal of the Academy of Breastfeeding Medicine JO - Breastfeed Med VL - 11 IS - 2 N2 - BACKGROUND: Exclusive breastfeeding (EBF) is recommended for 6 months after delivery as the optimal infant feeding method and is especially important for prevention of mother-to-child HIV transmission (PMTCT). However, EBF promotion efforts among HIV-infected mothers in sub-Saharan Africa have achieved mixed success and require context-specific interventions. METHODS: HIV-positive, pregnant women from six clinics in Nairobi were enrolled into a clinic-level, before-after counseling intervention study. All women received standard perinatal and HIV care. Women in the intervention arm were offered three counseling sessions that promoted EBF, described its benefits, and explained breastfeeding techniques. Mother-infant pairs were followed until 14 weeks postpartum, with infant HIV testing at 6 weeks. EBF prevalence at 14 weeks postpartum was compared between study arms using log-binomial regression. Proportions of 6-week HIV-free survival and 14-week infant survival were assessed using Cox regression. Risk estimates were adjusted for clinic, relationship status, and antiretroviral therapy. RESULTS: Between 2009 and 2013, 833 women were enrolled of whom 94% planned to practice EBF for 6 months and 95% were taking therapeutic or prophylactic antiretrovirals. Median age was 27 years; median CD4 count was 403 cells/μL. EBF prevalence at 14 weeks postpartum was 86% in the control and 81% in the intervention group (p = 0.19). No differences were observed between groups for 6-week HIV-free survival and 14-week infant survival. CONCLUSION: Women who received breastfeeding counseling were not more likely to breastfeed exclusively, in part due to high overall EBF prevalence in this study population. The high EBF prevalence is an important finding, given recent efforts to promote EBF in Kenya. SN - 1556-8342 UR - https://www.unboundmedicine.com/medline/citation/26885769/High_Rates_of_Exclusive_Breastfeeding_in_Both_Arms_of_a_Peer_Counseling_Study_Promoting_EBF_Among_HIV_Infected_Kenyan_Women_ L2 - https://www.liebertpub.com/doi/full/10.1089/bfm.2015.0071?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -