The Impact of Safer Breastfeeding Practices on Postnatal HIV-1 Transmission in Zimbabwe
We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status. Mothers were tested for HIV and were encouraged--but n...
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| Published in | American journal of public health (1971) Vol. 97; no. 7; pp. 1249 - 1254 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Washington, DC
Am Public Health Assoc
01.07.2007
American Public Health Association American Journal of Public Health 2007 |
| Subjects | |
| Online Access | Get full text |
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| Abstract | We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status.
Mothers were tested for HIV and were encouraged--but not required--to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission.
Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status.
The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice. |
|---|---|
| AbstractList | Objectives. We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status.
Methods. Mothers were tested for HIV and were encouraged—but not required—to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission.
Results. Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status.
Conclusions. The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice. OBJECTIVES: We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status. METHODS: Mothers were tested for HIV and were encouraged-but not required-to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission. RESULTS: Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status. CONCLUSIONS: The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice. OBJECTIVESWe assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status.METHODSMothers were tested for HIV and were encouraged--but not required--to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission.RESULTSCumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status.CONCLUSIONSThe promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice. We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status. Mothers were tested for HIV and were encouraged--but not required--to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission. Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status. The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice. Objectives. We assessed the association between exposure to an educational intervention that emphasized safer breastfeeding practices and postnatal HIV transmission among 437 HIV-positive mothers in Zimbabwe, 365 of whom did not know their infection status. Methods. Mothers were tested for HIV and were encouraged—but not required—to learn their HIV status. Intervention exposure was assessed by a questionnaire, Turnbull methods were used to estimate postnatal HIV transmission, and multivariate Cox proportional hazard models were constructed to assess the association between intervention exposure and postnatal HIV transmission. Results. Cumulative postnatal HIV transmission was 8.2%; each additional intervention contact was associated with a 38% reduction in postnatal HIV transmission. HIV-positive mothers who were exposed to both print and video materials were 79% less likely to infect their infants compared with mothers who had no exposure. These findings were similar for mothers who did not know their HIV status. Conclusions. The promotion of exclusive breastfeeding has the potential to reduce postnatal HIV transmission among women who do not know their HIV status, and child survival and HIV prevention programs should support this practice. Each year, an estimated 700 000 children are infected with HIV by their mothers,1 and at least 40% of these transmissions occur during breastfeeding.2-3 The vast majority of HIV-infected children live in sub-Saharan Africa, where universal and prolonged breast-feeding protects children against diarrhea and other infections and contributes to birth spacing (i.e., intervals between pregnancies).4-6 Hence, the transmission of HIV through breastfeeding has created one of the most challenging dilemmas of the HIV pandemic and has contributed to reduced support for breastfeeding in some areas where there is a high prevalence of HIV7 International guidelines currently state that HIV-positive mothers should avoid all breast-feeding when replacement feeding is acceptable, feasible, affordable, sustainable, and safe. In 2005, we reported that women who enrolled in the trial after the intervention was implemented were more knowledgeable about HIV and were 8.4 times more likely to practice exclusive breastfeeding compared with women who enrolled in the trial before the intervention began.10 Furthermore, exclusive breastfeeding for at least 3 months was associated with significantly lower postnatal transmission and higher HIV-free survival compared with partial breastfeeding (i.e., animal milks or solid foods in addition to breastmilk).11 Our findings were consistent with previous reports from South Africa.12'13 In this study, we examined the association between the amount of exposure mothers had to the educational intervention and their infants' risk for postnatal HIV transmission or death. |
| Author | Ward, Brian J Humphrey, Jean H Moulton, Lawrence H Zunguza, Clare D Piwoz, Ellen G Iliff, Peter J Mutasa, Kuda Tavengwa, Naume V Nathoo, Kusum J Marinda, Edmore T |
| AuthorAffiliation | Ellen G. Piwoz is with the Center for Nutrition, Academy for Educational Development, Washington, DC. Jean H. Humphrey, Naume V. Tavengwa, Peter J. Iliff, and Kuda Mutasa are with the ZVITAMBO Project, Harare, Zimbabwe. Ellen G. Piwoz, Jean H. Humphrey, and Lawrence H. Moulton are with the Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md. Edmore T. Marinda is with the School of Public Health, University of Witswatersrand, Johannesburg, South Africa. Clare D. Zunguza is with the Harare City Health Department, Harare. Kusum J. Nathoo is with the College of Health Sciences, University of Zimbabwe, Harare. Brian J. Ward is with the Montreal General Hospital Research Institute, McGill University, Montreal, Quebec |
| AuthorAffiliation_xml | – name: Ellen G. Piwoz is with the Center for Nutrition, Academy for Educational Development, Washington, DC. Jean H. Humphrey, Naume V. Tavengwa, Peter J. Iliff, and Kuda Mutasa are with the ZVITAMBO Project, Harare, Zimbabwe. Ellen G. Piwoz, Jean H. Humphrey, and Lawrence H. Moulton are with the Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md. Edmore T. Marinda is with the School of Public Health, University of Witswatersrand, Johannesburg, South Africa. Clare D. Zunguza is with the Harare City Health Department, Harare. Kusum J. Nathoo is with the College of Health Sciences, University of Zimbabwe, Harare. Brian J. Ward is with the Montreal General Hospital Research Institute, McGill University, Montreal, Quebec |
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| Cites_doi | 10.1097/01.aids.0000166093.16446.c9 10.2105/AJPH.94.3.400 10.1001/jama.283.9.1167 10.1016/0140-6736(92)92115-V 10.1093/biomet/70.1.41 10.1086/500366 10.1016/S0140-6736(03)13811-1 10.1038/nri1393 10.1093/jn/135.4.950 10.1097/00002030-200102160-00011 10.1016/S0140-6736(00)03159-7 10.1086/314854 10.1002/sim.1076 10.1016/S0140-6736(99)01101-0 10.1002/sim.1092 10.1016/S0022-3476(78)80621-0 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B 10.1093/ajcn.81.2.454 10.1016/S0140-6736(98)08037-4 10.1086/420834 10.1111/j.2517-6161.1976.tb01597.x 10.1089/108729104322740910 10.1016/S0140-6736(04)17140-7 10.1542/peds.2004-2491 |
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| Keywords | Social environment Human Immunopathology HIV-1 virus Transmission Retroviridae AIDS Breast feeding Health education Sociocultural environment Immune deficiency Lentivirus Infection Virus Postnatal Viral disease Human immunodeficiency virus Safety Public health |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Peer Reviewed Contributors E. G. Piwoz participated in study origination, design, and implementation; conducted most of the analysis; and drafted the article. J. H. Humphrey participated in all aspects of the study, including origination, design, implementation, analysis, and drafting the article. N. V. Tavengwa participated in study design, implementation, and interpretation. P. J. Iliff participated in the origination and design of the study, its implementation, and drafting the article. E. T. Marinda and L. H. Moulton contributed to the statistical analysis. C. D. Zunguza contributed to study interpretation. K. J. Nathoo participated in study design, implementation, and interpretation. K. Mutasa was responsible for all laboratory analyses. B. J. Ward contributed to the study's origination, design and interpretation. All primary authors reviewed final draft of the article. Requests for reprints should be sent to Jean Humphrey, ScD, ZVITAMBO Project, #1 Borrowdale Rd, Borrowdale, Harare, Zimbabwe (e-mail: jhumphrey@zvitambo.co.zw). |
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| SubjectTerms | Adult AIDS Serodiagnosis Babies Biological and medical sciences Breast Feeding Breastfeeding & lactation Brochures Children & youth Condoms Counseling Disease transmission Enzyme-Linked Immunosorbent Assay Female Health Education - methods HIV HIV Infections - epidemiology HIV Infections - prevention & control HIV Infections - transmission HIV-1 Human immunodeficiency virus Human immunodeficiency virus 1 Human viral diseases Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infant Infant, Newborn Infectious Disease Transmission, Vertical - prevention & control Infectious diseases Medical sciences Medical tests Milk, Human - virology Miscellaneous Mothers Outcome Assessment, Health Care Polymerase Chain Reaction Proportional Hazards Models Public health Public health. Hygiene Public health. Hygiene-occupational medicine Recruitment Research and Practice Viral diseases Viral diseases of the lymphoid tissue and the blood. Aids Vitamin A Zimbabwe - epidemiology |
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| Title | The Impact of Safer Breastfeeding Practices on Postnatal HIV-1 Transmission in Zimbabwe |
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