Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.
Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Int Breastfeed J. 2021 Oct 13;16(1):81. doi: 10.1186/s13006-021-00424-x.
Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy.
From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice.
Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy.
In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.
博茨瓦纳于 2016 年 5 月更新了其抗逆转录病毒治疗（ART）指南，以支持在怀孕期间已记录到 HIV RNA 抑制的接受 ART 的艾滋病毒感染者（HIV 感染者）进行母乳喂养。
在 Tsepamo 研究中，我们于 2016 年 9 月至 2019 年 3 月，在博茨瓦纳的八家政府妇产科病房中评估了 HIV 感染者在出院时的喂养方式。我们使用预防母婴传播 HIV（PMTCT）咨询师报告、婴儿配方奶粉配给日志或直接观察，在产科记录中验证记录的喂养方式。从产科记录和门诊 HIV 记录（从 2018 年 2 月开始）中记录了可用的 HIV RNA 结果。在部分参与者中，我们使用电子实验室记录来验证是否进行了 HIV RNA 检测。使用单变量和多变量逻辑回归分析来确定与婴儿喂养选择相关的因素。
在 13354 名在出院时经过验证的喂养方式的 HIV 感染者中，有 5303 名（39.7%）选择母乳喂养，8051 名（60.3%）选择配方奶喂养。在分娩时提供给医疗保健提供者的产科记录中有记录的 HIV RNA 结果的妇女更有可能选择母乳喂养（50.8%），而没有记录的 HIV RNA 结果的妇女则不太可能选择母乳喂养（35.4%）（优势比 0.59；95%CI 0.54，0.65）。在有记录的 HIV RNA 的妇女中，有 2711 名（94.6%）病毒得到抑制（<400 拷贝/ml）。尽管不符合标准，但仍有相当一部分妇女进行了母乳喂养，包括 153 名 HIV RNA>400 拷贝/ml 的妇女中有 46 名（30.1%），489 名未报告使用 ART 的妇女中有 134 名（27.4%）。对 150 名产科记录中未记录结果的妇女进行的一项电子实验室记录子分析显示，93 名（62%）妇女在怀孕期间进行了 HIV RNA 检测。
在长期使用抑制性 ART 的背景下，大多数 HIV 感染者从受孕开始就使用 ART，需要在产科记录中记录 HIV RNA 抑制情况，以便为婴儿喂养决策提供信息，但这可能会成为母乳喂养的障碍，但不太可能阻止大量 HIV 传播。
