Exclusive breastfeeding among HIV-positive mothers receiving lifelong ART from PMTCT clinics in Kigali, Rwanda
Background: In low-resource countries with unsafe replacement feeding options, HIV-infected women are advised to exclusively breastfeed (EBF) for the first six months while on a regimen of antiretroviral therapy (ART). The Kabeho (Kigali Antiretroviral and Breastfeeding Assessment for the Elimination of HIV) Study is an observational prospective study of 24 month HIV-free survival of infants born to HIV-positive women attending antenatal clinics participating in the Rwanda National Prevention of Mother-To-Child Transmission (PMTCT) program, implementing lifelong ART, (''Option B+''). These analyses evaluated individual and facility factors associated with duration of EBF to 6 months postpartum.
Methods: HIV-positive women from 14 health facilities in Kigali were followed at monthly clinic visits. Self-reported infant feeding practices were recorded at each visit. We estimated longitudinal logistic regression models of EBF including all observations up to 6.5 months of age (n=3295 observations, 590 infants surviving>2 days). We considered individual and facility-level factors.
Results: Overall, 97.6% of mothers initiated breastfeeding; however, EBF declined rapidly after first 3 months postpartum. By 6.5 months, less than half (43%) of infants were exclusively breastfed (Figure 1). Likelihood of EBF was significantly lower among women with higher education, living in households with higher socioeconomic status, and with a twin or cesarean delivery. A higher facility factor score (more staff training related to infant feeding) and provision of infant feeding counseling were strongly associated higher likelihood of EBF across all ages.
Conclusions: Results show that adherence to 6 months of EBF rapidly declined after 3 months postpartum in Kabeho mothers. Given the strong association of facility factors with EBF, Option B+ programs should focus on improving infant feeding counseling at facilities by staff well-trained in comprehensive infant feeding and support. 
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G. Ndayisaba1, L. Adair2, K. Riggle2, D. Ndatimana1, E. Bobrow3, P. Mugwaneza4, J. Condo5, A. Asiimwe6
1Elizabeth Glaser Paediatric AIDS Foundation, Kigali, Rwanda, 2University of North Carolina, Chapel Hill, United States, 3Elizabeth Glaser Paediatric AIDS Foundation, Washington DC, United States, 4Rwanda Ministry of Health, Kigali, Rwanda, 5College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda, 6Rwanda University Teaching Hospitals, Kigali, Rwanda