A Review of Evidence for Transmission of HIV From Children to Breastfeeding Women and Implications for Prevention

Little, Kristen; Kilmarx, Peter H.; Taylor, Allan W.; Rose, Charles E.; Rivadeneira, Emilia; Nesheim, Steven

doi:10.1097/inf.0b013e318261130f

Cited by 22 publications

(14 citation statements)

References 25 publications

(29 reference statements)

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“…Many of the studies on the impact of infant feeding methods and exposure to various ART regimens were conducted before the 2010 WHO PMTCT. [ 55 , 57 ] Although infant feeding results were available from only a minority of studies in this review, the results of the review are in agreement with the findings which led to the current guidelines. In the countries under review breastfeeding is very common, and breastfed infants have an increased risk of MTCT of HIV.…”

Section: Discussionsupporting

confidence: 74%

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

Gumede-Moyo

Filteau²,

Munthali³

et al. 2017

Medicine

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Background:To synthesize and evaluate the impact of implementing post-2010 World Health Organization (WHO) prevention of mother-to-child transmission (PMTCT) guidelines on attainment of PMTCT targets.Methods:Retrospective and prospective cohort study designs that utilized routinely collected data with a focus on provision and utilization of the cascade of PMTCT services were included. The outcomes included the proportion of pregnant women who were tested during their antenatal clinic (ANC) visits; mother-to-child transmission (MTCT) rate; adherence; retention rate; and loss to follow-up (LTFU).Results:Of the 1210 references screened, 45 met the inclusion criteria. The studies originated from 14 countries in sub-Saharan Africa. The highest number of studies originated from Malawi (10) followed by Nigeria and South Africa with 7 studies each. More than half of the studies were on option A while the majority of option B+ studies were conducted in Malawi. These studies indicated a high uptake of human immunodeficiency virus (HIV) testing ranging from 75% in Nigeria to over 96% in Zimbabwe and South Africa. High proportions of CD4 count testing were reported in studies only from South Africa despite that in most of the countries CD4 testing was a prerequisite to access treatment. MTCT rate ranged from 1.1% to 15.1% and it was higher in studies where data were collected in the early days of the WHO 2010 PMTCT guidelines. During the postpartum period, adherence and retention rate decreased, and LTFU increased for both HIV-positive mothers and exposed infants.Conclusion:Irrespective of which option was followed, uptake of antenatal HIV testing was high but there was a large drop off along later points in the PMTCT cascade. More research is needed on how to improve later components of the PMTCT cascade, especially of option B+ which is now the norm throughout sub-Saharan Africa.

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Section: Discussionsupporting

confidence: 74%

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

Gumede-Moyo

Filteau²,

Munthali³

et al. 2017

Medicine

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“…11 Advice regarding breastfeeding is clearly a matter of concern. Previous studies have found that HIV and hepatitis B virus appear in breast milk and cause mother-to-infant transmission; 26,27 and that mothers with COVID-19 can transmit the virus through respiratory droplets or skin contact during breastfeeding. In contrast to a study that did not find SARS-CoV-2 in the breast milk of women with COVID-19, 7 we found a positive viral nucleic acid test in one breastmilk sample.…”

Section: Discussionmentioning

confidence: 99%

Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding

Liu

Dong

et al. 2020

BJOG

189

213

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“…Practice of breastfeeding among the HIV positive mothers was high as majority of them perceived breast milk as beneficial to their infants, hence they breastfed their infants. Although current PMTCT guidelines promote exclusive breastfeeding as a feeding option for HIV-exposed infants (HEI), at the time of this study, HIV positive mothers were not encouraged to breastfeed in order to prevent transmission of the virus to their infants [ 25 , 26 ]. Breastfeeding of infants is a social norm among Africans, and some studies have reported that since mothers who failed to breastfeed their babies were suspected of having HIV, many HIV positive mothers choose to breastfeed their infants to prevent this suspicion and the resultant stigma [ 27 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria

et al. 2018

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BackgroundAlthough the risk of HIV transmission through breastfeeding is reduced considerably with the use of antiretroviral therapy, infant feeding by HIV positive mothers remains controversial. Weighing risks against benefits generates intense debate among policymakers, program managers and service providers in sub-Saharan Africa, considering that the major causes of infant death of malnutrition and infectious diseases, could be prevented if mothers breastfeed their babies. Whereas breastfeeding involves some risk of HIV transmission, not breastfeeding poses considerable risk to infant survival. This study investigated perceptions and practice of breastfeeding of HIV-exposed infants among HIV positive mothers.MethodsA cross-sectional descriptive study was conducted in Enugu metropolis among HIV positive mothers receiving care for prevention of mother-to-child transmission of HIV from two public and two private hospitals. Interviewer-administered questionnaire survey was done with 550 participants as they exited the final point of service delivery. Descriptive statistics of perception and practice variables and cross tabulation of selected variables was performed.ResultsMost mothers knew that HIV could be transmitted through breast milk. The majority perceived any type of breastfeeding as beneficial to the infant: 230 (83.6%) in private facilities, and 188 (68.4%) public facilities. Over three-quarters of the mothers breastfed their infants and their reasons for breastfeeding included personal choice, cultural norms, fear of HIV status being disclosed and pressure from family members. A statistical significant association was found between; (i) practice of breastfeeding and marital status, (p < 0.01), and (ii) practice of breastfeeding and household income provider (p = 0.02). However, neither marital status (AOR 1.4; 95% CI 0.3, 6.8) nor being the household income provider (AOR 4.9; 95% CI 0.6, 12.9) is a significant predictor of breastfeeding of HIV-exposed infants.ConclusionsBreastfeeding remains a common trend among HIV positive women and it is associated with economic independence of women and social support. Fear of stigma negatively affects practice of breastfeeding. Hence, HIV positive mothers need economic independence and the support of family members to practice recommended infant feeding options.

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A Review of Evidence for Transmission of HIV From Children to Breastfeeding Women and Implications for Prevention

Cited by 22 publications

References 25 publications

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

Implementation effectiveness of revised (post-2010) World Health Organization guidelines on prevention of mother-to-child transmission of HIV using routinely collected data in sub-Saharan Africa

Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding

Perception and practice of breastfeeding among HIV positive mothers receiving care for prevention of mother to child transmission in South-East, Nigeria

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