“求你了……给宝宝喂奶，情况变了”：在不断变化的预防产后传播指南背景下，感染艾滋病毒的乌干达母亲的婴儿喂养经验。
"I beg you…breastfeed the baby, things changed": infant feeding experiences among Ugandan mothers living with HIV in the context of evolving guidelines to prevent postnatal transmission.
机构信息
Faculty of Health Sciences, Simon Fraser University, Blusson Hall Rm 10522, 8888 University Drive, Burnaby, B.C. V5A 1S6, Canada.
Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
出版信息
BMC Public Health. 2018 Jan 29;18(1):188. doi: 10.1186/s12889-018-5081-x.
BACKGROUND
For women living with HIV (WLWH) in low- and middle-income countries, World Health Organization (WHO) infant feeding guidelines now recommend exclusive breastfeeding until six months followed by mixed feeding until 24 months, alongside lifelong maternal antiretroviral therapy (ART). These recommendations represent the sixth major revision to WHO infant feeding guidelines since 1992. We explored how WLWH in rural Uganda make infant feeding decisions in light of evolving recommendations.
METHODS
We conducted semi-structured interviews with 20 postpartum Ugandan WLWH accessing ART, who reported pregnancy < 2 years prior to recruitment. Interviews were conducted between February-August 2014 with babies born between March 2012-October 2013, over which time, the regional HIV treatment clinic recommended lifelong ART for all pregnant and breastfeeding women (Option B+). Content analysis was used to identify major themes. Infant feeding experiences was an emergent theme. NVivo 10 software was used to organize analyses.
RESULTS
Among 20 women, median age was 33 years [IQR: 28-35], number of livebirths was 3 [IQR: 2-5], years on ART was 2.3 [IQR: 1.5-5.1], and 95% were virally suppressed. Data revealed that women valued opportunities to reduce postnatal transmission. However, women made infant feeding choices that differed from recommendations due to: (1) perception of conflicting recommendations regarding infant feeding; (2) fear of prolonged infant HIV exposure through breastfeeding; and (3) social and structural constraints shaping infant feeding decision-making.
CONCLUSIONS
WLWH face layered challenges navigating evolving infant feeding recommendations. Further research is needed to examine guidance and decision-making on infant feeding choices to improve postpartum experiences and outcomes. Improved communication about changes to recommendations is needed for WLWH, their partners, community members, and healthcare providers.
背景
对于中低收入国家的 HIV 阳性女性（WLWH），世界卫生组织（WHO）的婴儿喂养指南现在建议在 6 个月之前进行纯母乳喂养，然后在 24 个月之前进行混合喂养，同时还需要终身接受抗逆转录病毒治疗（ART）。这些建议是自 1992 年以来，WHO 婴儿喂养指南的第六次重大修订。我们探讨了乌干达农村地区的 WLWH 如何根据不断发展的建议做出婴儿喂养决策。
方法
我们对 20 名正在接受 ART 治疗的产后乌干达 WLWH 进行了半结构化访谈，这些女性在招募前的 2 年内怀孕。访谈于 2014 年 2 月至 8 月进行，所涉及的婴儿出生于 2012 年 3 月至 2013 年 10 月之间，在此期间，区域 HIV 治疗诊所建议所有孕妇和哺乳期妇女终身接受 ART（Option B+）。使用内容分析法识别主要主题。婴儿喂养经验是一个新出现的主题。使用 NVivo 10 软件组织分析。
结果
在 20 名女性中，中位年龄为 33 岁[IQR：28-35]，活产数为 3[IQR：2-5]，ART 治疗时间为 2.3[IQR：1.5-5.1]，95%的人病毒得到抑制。数据显示，女性重视减少产后传播的机会。然而，由于以下原因，女性做出了与建议不同的婴儿喂养选择：（1）对婴儿喂养方面相互矛盾的建议的看法；（2）担心通过母乳喂养延长婴儿 HIV 暴露时间；（3）影响婴儿喂养决策的社会和结构性限制。
结论
WLWH 在应对不断发展的婴儿喂养建议时面临着多方面的挑战。需要进一步研究，以检查婴儿喂养选择方面的指导和决策，以改善产后体验和结果。需要向 WLWH、她们的伴侣、社区成员和医疗保健提供者提供有关建议变更的更好的沟通。
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