Abstract
BackgroundPartners In Health (PIH) works with the Ministry of Health to provide comprehensive health services in Haiti. Between 1994 and 2009, PIH recommended exclusive formula feeding in the prevention of mother-to-child transmission (PMTCT) of HIV program and provided support to implement this strategy. We conducted this study to assess HIV-free survival and prevalence of diarrhea and malnutrition among infants in our PMTCT program in rural Haiti where exclusive formula feeding was supported.MethodsWe reviewed medical charts of PMTCT mother-infant pairs at PIH between November 2004 and August 2006 through a retrospective longitudinal study and cross-sectional survey. We performed household surveys for each pair and at control households matched by infant's age and gender.Results254 mother-infant pairs were included. 15.3% of infants were low birth weight; most births occurred at home (68.8%). 55.9% of households had no latrine; food insecurity was high (mean score of 18; scale 0-27, SD = 5.3). HIV-free survival at 18 months was 90.6%. Within the cohort, 9 children (3.5%) were HIV-infected and 17 (6.7%) died. Community controls were more likely to be breastfed (P = 0.003) and more likely to introduce food early (P = 0.003) than PMTCT-program households. There was no difference in moderate malnutrition (Z score ≤ 2 SD) between PMTCT and community groups after controlling for guardian's education, marital status, and food insecurity (OR = 1.05; 95% CI: 0.67, 1.64; P = 0.84). Diarrhea was 2.9 times more prevalent among community children than PMTCT infants (30.3% vs. 12.2%; P < 0.0001).ConclusionsIn a PIH-supported program in rural Haiti that addressed socioeconomic barriers to ill-health, breast milk substitution was safe, acceptable and feasible for PMTCT for HIV-infected women choosing this option.
Highlights
It is estimated that more than 33.3 million people are living with HIV/AIDS worldwide, 2.5 million of whom are children [1]
Until November 2009, the World Health Organization (WHO) guidelines recommended that infants born to HIV-infected mothers be exclusively breastfed for six months followed by rapid weaning in settings where it was unlikely that exclusive formula feeding was “acceptable, feasible, affordable, sustainable and safe” [6,7]
The objective of this study was to assess HIV-free survival among a cohort of infants born to HIV-positive women enrolled in a community-based prevention of mother-to-child transmission of HIV (PMTCT) program in rural Haiti between November 1, 2004 and August 31, 2006
Summary
It is estimated that more than 33.3 million people are living with HIV/AIDS worldwide, 2.5 million of whom are children [1]. Until November 2009, the World Health Organization (WHO) guidelines recommended that infants born to HIV-infected mothers be exclusively breastfed for six months followed by rapid weaning in settings where it was unlikely that exclusive formula feeding was “acceptable, feasible, affordable, sustainable and safe” [6,7]. Between 1994 and 2009, PIH recommended exclusive formula feeding in the prevention of mother-tochild transmission (PMTCT) of HIV program and provided support to implement this strategy. We conducted this study to assess HIV-free survival and prevalence of diarrhea and malnutrition among infants in our PMTCT program in rural Haiti where exclusive formula feeding was supported. Contrary to concern that recommending breast milk substitution in this targeted population would undermine attempts to reinforce breastfeeding as best practice for the general population ("spillover”), community mothers in our study had higher rates of exclusive breastfeeding than the general population. There are improvements to be made in the general population’s breastfeeding practices, this shows that there is little to no evidence to suggest that “spillover” is occurring in the Haiti program
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