title: Low adherence to recommended infant feeding strategies among HIV-infected women: results from the pilot phase of a randomized trial to prevent mother-to-child transmission in Botswana.
abstract: Little is known about the ability of women to adhere to recommended feeding strategies to prevent mother-to-child HIV transmission (MTCT) from breast milk. We conducted a pilot study in rural Botswana to prevent MTCT from breast milk. Women were randomized to formula feed their infants or to exclusively breastfeed while providing prophylactic zidovudine. Women who chose to formula feed independently were also followed. Among those with > or = 3 postpartum visits, none of 31 women assigned to breastfeed did so exclusively for 5 months. Seven (22%) of 32 women in the formula arm definitely or probably breastfed by self-report or as witnessed in maternity, and evidence of breast milk on physical examination was present in 50% of women in > or = 2 visits beyond 1 month. Three (18%) of 17 women choosing formula definitely or probably breastfed, and breast milk was present on exam in 53%. We conclude that adherence to 5 months of exclusive breastfeeding did not occur, and that adherence to exclusive formula feeding was sub-optimal and potentially over reported. Breast examination may be a useful adjunct to self-report, but needs to be validated and standardized. Low adherence to infant feeding strategies that differ from local norms will reduce their effectiveness in preventing MTCT.
authors.affiliation: Botswana-Harvard AIDS Institute Partnership, Botswana. rshapiro@hsph.harvard.edu
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Ibou
authors.initials: I
authors.lastname: Thior
authors.forename: Lisa
authors.initials: L
authors.lastname: Stocking
authors.forename: Poloko
authors.initials: P
authors.lastname: Kebaabetswe
authors.forename: Carolyn
authors.initials: C
authors.lastname: Wester
authors.forename: Trevor
authors.initials: T
authors.lastname: Peter
authors.forename: Richard
authors.initials: R
authors.lastname: Marlink
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: S Jody
authors.initials: SJ
authors.lastname: Heymann
mesh_terms: D001902:Botswana / Q000453:epidemiology; D001942:Breast Feeding / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000706:statistics & numerical data*; D007225:Infant Food / Q000706:statistics & numerical data*; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010865:Pilot Projects; D012424:Rural Population / Q000706:statistics & numerical data