title: Feasibility of using flash-heated breastmilk as an infant feeding option for HIV-exposed, uninfected infants after 6 months of age in urban Tanzania.
abstract: OBJECTIVE
  Heat-treating expressed breastmilk is recommended as an interim feeding strategy for HIV-exposed infants in resource-poor countries, but data on its feasibility are minimal. Flash-heating (FH) is a simple in-home technique for heating breastmilk that inactivates HIV although preserving its nutritional and anti-infective properties. Our primary objective was to determine, among HIV-infected mothers, the feasibility and protocol adherence of FH expressed breastmilk after 6 months of exclusive breastfeeding.
  
  
  METHODS
  Prospective longitudinal.
  
  
  METHODS
  One hundred one HIV-infected breastfeeding mothers.
  
  
  METHODS
  Dar es Salaam, Tanzania.
  
  
  METHODS
  Peer counselors provided in-home counseling and support on infant feeding from 2 to 9 months postpartum. Mothers were encouraged to exclusively breastfeed for 6 months followed by FH expressed breastmilk if her infant was HIV negative. Clinic-based staff measured infant growth and morbidity monthly, and mothers kept daily logs of infant morbidity. FH behavior was tracked until 9 months postpartum using daily logs, in-home observations, and clinic-based and home-based surveys. Bacterial cultures of unheated and heated milk samples were performed.
  
  
  RESULTS
  Thirty-seven of 72 eligible mothers (51.4%) chose to flash-heat. Median (range) frequency of milk expression was 3 (1-6) times daily and duration of method use on-study was 9.7 (0.1-15.6) weeks. Mean (SD) daily milk volume was 322 (201) mL (range 25-1120). No heated and 32 (30.5%) unheated samples contained bacterial pathogens.
  
  
  CONCLUSIONS
  FH is a simple technology that many HIV-positive women can successfully use after exclusive breastfeeding to continue to provide the benefits of breastmilk while avoiding maternal-to-child transmission associated with nonexclusive breastfeeding. Based on these feasibility data, a clinical trial of the effects of FH breastmilk on infant health outcomes is warranted.
authors.affiliation: Department of Pediatrics, University California Davis Medical Center, Sacramento, CA, USA.
authors.forename: Caroline J
authors.initials: CJ
authors.lastname: Chantry
authors.forename: Sera L
authors.initials: SL
authors.lastname: Young
authors.forename: Waverly
authors.initials: W
authors.lastname: Rennie
authors.forename: Monica
authors.initials: M
authors.lastname: Ngonyani
authors.forename: Clara
authors.initials: C
authors.lastname: Mashio
authors.forename: Kiersten
authors.initials: K
authors.lastname: Israel-Ballard
authors.forename: Janet
authors.initials: J
authors.lastname: Peerson
authors.forename: Margaret
authors.initials: M
authors.lastname: Nyambo
authors.forename: Mecky
authors.initials: M
authors.lastname: Matee
authors.forename: Deborah
authors.initials: D
authors.lastname: Ash
authors.forename: Kathryn
authors.initials: K
authors.lastname: Dewey
authors.forename: Peggy
authors.initials: P
authors.lastname: Koniz-Booher
mesh_terms: D000293:Adolescent; D000328:Adult; D000886:Anthropometry; D001419:Bacteria / Q000302:isolation & purification; D004032:Diet / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008137:Longitudinal Studies; D008895:Milk, Human / Q000382:microbiology / Q000528:radiation effects*; D061352:Pasteurization / Q000379:methods*; D011446:Prospective Studies; D013636:Tanzania; D055815:Young Adult