Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
School of Public Health, Imperial College London, London, UK.
Matern Child Health J. 2021 Sep;25(9):1376-1391. doi: 10.1007/s10995-021-03155-x. Epub 2021 May 5.
In resource-constrained settings, infant feeding decisions among women with HIV (WHIV) must balance the risk of infant HIV acquisition from breastfeeding with increased mortality associated with formula feeding. WHO guidelines recommend countries principally promote a single feeding method for WHIV, either breastfeeding or formula feeding. In 2016, Botswana revised its policy of formula feeding for infants born to WHIV, instead promoting exclusive breastfeeding during the first 6 months of life.
We sought to understand factors influencing infant feeding choices among WHIV by administering a questionnaire to pregnant and postpartum WHIV (2013-2015) participating in a clinical trial in Botswana (the Mpepu Study). Logistic regression analyses were used to identify factors associated with infant feeding choices.
Of 810 surveyed participants, 24.0% chose breastfeeding and 76.0% chose formula feeding. Women were more likely to choose formula feeding if advised by a health worker to formula feed (aOR 1.90; 95% CI 1.02-3.57) or if they harboured doubts about the potency of antiretroviral treatment (ART) to prevent infant HIV acquisition (aOR 9.06; 95% CI 4.78-17.17). Women who reported lack of confidence in preparing infant formula safely (aOR 0.09; 95% CI 0.04-0.19) or low concerns about infant HIV acquisition (aOR 0.35; 95% CI 0.22-0.55) were significantly less likely to formula feed.
Perceptions about ART effectiveness, social circumstances and health worker recommendations were key influencers of infant feeding choices among WHIV. Health system factors and maternal education interventions represent ideal targets for any programmatic actions aiming to shape informed decision-making towards HIV-free survival of infants.
在资源有限的情况下，感染艾滋病毒的妇女（WHIV）的婴儿喂养决策必须在母乳喂养导致婴儿感染艾滋病毒的风险与配方奶喂养相关的死亡率增加之间取得平衡。世卫组织指南建议各国主要为 WHIV 推广单一的喂养方法，无论是母乳喂养还是配方奶喂养。2016 年，博茨瓦纳修订了其针对 WHIV 所生婴儿的配方奶喂养政策，转而提倡在婴儿生命的前 6 个月内进行纯母乳喂养。
我们通过向参与博茨瓦纳一项临床试验（Mpepu 研究）的孕妇和产后 WHIV（2013-2015 年）发放问卷，试图了解影响 WHIV 婴儿喂养选择的因素。我们使用逻辑回归分析来确定与婴儿喂养选择相关的因素。
在接受调查的 810 名参与者中，24.0%选择母乳喂养，76.0%选择配方奶喂养。如果卫生工作者建议配方奶喂养（优势比 1.90；95%置信区间 1.02-3.57），或者妇女对抗逆转录病毒治疗（ART）预防婴儿 HIV 感染的效力存在疑虑（优势比 9.06；95%置信区间 4.78-17.17），她们更有可能选择配方奶喂养。报告缺乏安全制备婴儿配方奶信心（优势比 0.09；95%置信区间 0.04-0.19）或对婴儿 HIV 感染关注度低（优势比 0.35；95%置信区间 0.22-0.55）的妇女，选择配方奶喂养的可能性显著降低。
对 ART 有效性、社会环境和卫生工作者建议的看法是 WHIV 婴儿喂养选择的关键影响因素。卫生系统因素和孕产妇教育干预措施是任何旨在塑造知情决策以实现婴儿无 HIV 生存的方案行动的理想目标。
