Factors affecting breastfeeding cessation after discontinuation of antiretroviral therapy to prevent mother-to-child transmission of HIV

Abstract

In the Kisumu Breastfeeding Study (KiBS), prevention of mother-to-child HIV transmission study, highly active antiretroviral therapy (HAART) is provided from 34 weeks gestation, through delivery to six months postpartum. The study recommends that women practice exclusive breastfeeding for six months, then wean abruptly. We sought to explore factors such as, education, family support, cultural norms, and sources of information about perinatal HIV transmission, which may influence a mother's decision to comply or not comply with the study's recommendation to stop breastfeeding when HAART is discontinued. We used semi-structured interviews of a purposive sample of 18 mothers participating in the KiBS. By interviewing 10 mothers who stopped breastfeeding and eight mothers who continued, it was possible to examine how different factors may have affected the groups of participants. All participants stated that it was not traditional to stop breastfeeding at six months. Participants who stopped breastfeeding reported more family support, were more educated, and were more likely to disclose their HIV status. Participants who continued breastfeeding more often expressed concern about stigma. Participants learned about mother-to-child transmission from clinics, churches, community groups, and other HIV-positive mothers. This substudy suggests that family support, education, and cultural norms are important factors that may influence a mother's decision regarding breastfeeding cessation. Thus, counseling and family support may play integral roles in the promotion of early breastfeeding cessation.

Keywords:

• HIV
• mother-to-child transmission
• breastfeeding cessation
• prevention

Acknowledgements

We would like to thank the mothers who were interviewed for this study. We wish to acknowledge Phoebe Okola, Jane Omanga, and Mary Othanya at the Kenya Medical Research Institute and Centers for Disease Control and Prevention in Kisumu for conducting the interviews and assisting with transcription and translation. We would also like to acknowledge the following staff at the Kenya Medical Research Institute and Centers for Disease Control and Prevention in Kisumu: John Okanda, Richard Ndivo, and Vitalis Sewe. We also thank Dr Michael Thigpen and Dr Thomas Painter at the Centers for Disease Control and Prevention in Atlanta for commenting on the study protocol. Finally, we thank Dr Harold Jaffe and Dr Premila Webster at the Department of Public Health, University of Oxford for commenting on the study protocol and manuscript. This study was supported by the Department of Public Health at the University of Oxford. This paper is published with an approval of the Acting Director of the Kenya Medical Research Institute.