Breastfeeding practices and beliefs among HIV+ pregnant and lactating women on antiretroviral therapy in rural Uganda indicate obstacles to following national guidelines

Abstract

Ugandan guidelines recommend 6 months of exclusive breastfeeding (EBF) for HIV‐infected women on antiretroviral therapy (ART), with continued breastfeeding (BF) for at least 1 year. We explored infant feeding (IF) practices and beliefs among HIV‐infected pregnant and BF women on ART in the PROMOTE trial (NCT00993031) in Tororo, Uganda. IF practices were determined using monthly maternal reports from a prospective cohort of 219 PROMOTE infants born between March 6, 2010 and October 31, 2011 and compared to 2007 Ugandan Demographic and Health Survey (DHS) data. To assess IF beliefs, a purposive sample of 24 pregnant and 32 BF PROMOTE participants took part in in‐depth interviews (IDIs) in July and August 2011 (n=56). In the PROMOTE study, the prevalence of EBF was 90.4% and 71.6% at 3 and 6 months, vs. 64.8% and 10.8% respectively in the DHS. In contrast, the prevalence of BF at 12 months was 62.6% in PROMOTE vs. 88.3% in DHS. IDIs revealed several potential reasons for suboptimal IF: 64.3% believed that HIV was an important reason to avoid BF and 21.4% did not know the recommended duration of EBF. Of BF IDI participants, 78.1% were concerned about adequate breast milk production and 46.9% had actually experienced problems with EBF, e.g. unsatisfied baby. Among all IDI participants, 96.4% desired further IF education. Further research is needed to understand optimal support to overcome identified obstacles to BF among HIV+ women in rural Uganda.Grant Funding Source: National Institute of Child Health and Human Development