title: Acceptability of formula-feeding to prevent HIV postnatal transmission, Abidjan, Côte d'Ivoire: ANRS 1201/1202 Ditrame Plus Study.
abstract: OBJECTIVE
  To describe the maternal acceptability of formula-feeding proposed to reduce postnatal HIV transmission in Abidjan, Côte d'Ivoire.
  
  
  METHODS
  Each consenting HIV-infected pregnant women, age > or =18 years, who received a perinatal antiretroviral prophylaxis was eligible. Two hierarchical infant-feeding options were proposed antenatally: exclusive formula-feeding or short-term exclusive breast-feeding. Formula-feeding was provided free up to age 9 months. Determinants of acceptability were analyzed using a logistic regression. Formula-feeding failure was defined as having breast-fed one's child at least once.
  
  
  RESULTS
  Between March 2001 and March 2003, 580 women delivered: 97% expressed their infant-feeding choice before delivery; 53% chose formula-feeding. Significant prenatal determinants for refusing formula-feeding were: living with her partner, being Muslim, having a low educational level, being followed in one of the study sites, having not disclosed her HIV status, and having been included within the first 6 months of the project. Among the 295 mothers who formula-fed, the Kaplan-Meier probability of success of the formula-feeding option was 93.6% at Day 2 (95% confidence interval [CI]: 90.7% to 96.3%) and 84.2% at 12 months (95% CI: 79.9% to 88.5%): 46 of 295 (15.6%) women breast-fed at least once, of whom 41% temporarily practiced mixed-feeding at Day 2 because of social stigma or newborn poor health.
  
  
  CONCLUSIONS
  In settings with general access to clean water, structured antenatal counseling, and sustained provision of free formula, slightly over half of HIV-infected women chose to artificially feed their newborn infant. Low mixed-feeding rates were observed. This social acceptability must be balanced with mother-child long-term health outcomes to guide safe recommendations on infant-feeding among HIV-infected women in African urban settings.
authors.affiliation: INSERM, 593 Institut de Santé Publique, Epidémiologie et Développement (ISPED), Université Victor Segalen, Bordeaux, France. valeriane.leroy@isped.u-bordeaux2.fr
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Charlotte
authors.initials: C
authors.lastname: Sakarovitch
authors.forename: Ida
authors.initials: I
authors.lastname: Viho
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
authors.forename: Didier Koumavi
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Laurence
authors.initials: L
authors.lastname: Bequet
authors.forename: François
authors.initials: F
authors.lastname: Rouet
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Marguerite
authors.initials: M
authors.lastname: Timite-Konan
mesh_terms: D001942:Breast Feeding / Q000009:adverse effects; D015331:Cohort Studies; D007560:Cote d'Ivoire; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007225:Infant Food; D041943:Infant Formula; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008895:Milk, Human / Q000821:virology*; D011446:Prospective Studies; D014886:Weaning