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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.
BMC Public Health. 2018 Jan 29; 18(1):188.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.
Guideline: Updates on HIV and infant feeding. The duration of breastfeeding and support from health services to improve feeding practices among mothers living with HIV.
Geneva, Switzerland, WHO, 2016.  p.The objective of this guideline is to improve the HIV-free survival of HIV-exposed infants by providing guidance on appropriate infant feeding practices and use of ARV drugs for mothers living with HIV and by updating WHO-related tools and training materials. The guideline is intended mainly for countries with high HIV prevalence and settings in which diarrhoea, pneumonia and undernutrition are common causes of infant and child mortality. However, it may also be relevant to settings with a low prevalence of HIV depending on the background rates and causes of infant and child mortality. This guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate nutrition actions to achieve the Sustainable Development Goals, the global targets set in the comprehensive implementation plan on maternal, infant and young child nutrition, the Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030) and the Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021. The target audience for this guideline includes: (1) national policy-makers in health ministries; (2) programme managers working in child health, essential drugs and health worker training; (3) health-care providers, researchers and clinicians providing services to pregnant women and mothers living with HIV at various levels of health care; and (4) development partners providing financial and/or technical support for child health programmes, including those in conflict and emergency settings. (Excerpt)
Geneva, Switzerland, WHO, 2015 Sep.  p. (Guidelines)This early-release guideline makes available two key recommendations that were developed during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches. The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV compared with delayed treatment. The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide variety of settings and populations. The recommendations in this guideline will form part of the revised consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016. The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support implementation.
Health outcomes and cost impact of the new WHO 2013 guidelines on prevention of mother-to-child transmission of HIV in Zambia.
PloS One. 2014; 9(3):e90991.BACKGROUND: Countries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either 'Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)' or 'Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)', while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia. METHODS: A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of =350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined. RESULTS: Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with 'ARVs during pregnancy and breastfeeding' and further reduced by 15% with 'Lifelong ART'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners. CONCLUSION: The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.
Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions.
International Journal of Health Planning and Management. 2013 Jul-Sep; 28(3):257-68.The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright (c) 2012 John Wiley & Sons, Ltd.
[Geneva, Switzerland], UNAIDS, .  p.The number of infants born with HIV infection is growing every day. The AIDS pandemic represents a tragic setback in the progress made on child welfare and survival. Given the vital importance of breast milk and breast-feeding for child health, the increasing prevalence of HIV infection around the world, and the evidence of a risk of HIV transmission through breast-feeding, it is now crucial that policies be developed on HIV infection and infant feeding. The following statement provides policy-makers with a number of key elements for the formulation of such policies. (excerpt)
WHO - UNAIDS - UNICEF Technical Consultation on HIV and Infant Feeding: Implementation of Guidelines. Report of a meeting -- Geneva, 20-22 April 1998.
Geneva, Switzerland, UNAIDS, 1998.  p.The Guidelines and Guide recognise that: HIV infection can be transmitted through breastfeeding. Appropriate alternatives to breastfeeding should be available and affordable in adequate amounts for women whom testing has shown to be HIV-positive. Breastfeeding is the ideal way to feed the majority of infants. Efforts to protect, promote and support breastfeeding by women who are HIV-negative or of unknown HIV status need to be strengthened; HIV-positive mothers should be enabled to make fully informed decisions about the best way to feed their infants in their particular circumstances. Whatever they decide, they should receive educational, psychosocial and material support to carry out their decision as safely as possible, including access to adequate alternatives to breastfeeding if they so choose; To make fully informed decisions about infant feeding, as well as about other aspects of HIV, mother-to-child transmission (MTCT) and reproductive life, women need to know and accept their HIV status. There is thus an urgent need to increase access to voluntary and confidential counselling and HIV testing (VCT), and to promote its use by women and when possible their partners, before making alternatives to breastfeeding available; An essential priority is primary prevention of HIV infection. Education for all adults of reproductive age, particularly for pregnant and lactating women and their sexual partners, and for young people, needs to be strengthened; Women who are HIV positive need to understand the particular importance of avoiding infection during pregnancy and lactation. (excerpt)
UN Chronicle. 2005 Dec;  p..The new campaign of the United Nations Children's Fund (UNICEF), "Unite for Children, Unite against AIDS", hopes to focus global attention on the devastating impact that the HIV/AIDS pandemic has had on children. Ann Veneman, UNICEF Executive Director, in launching the campaign at UN Headquarters in New York on 25 October 2005, described what AIDS means to the youngest generation. "It is a disease that has redefined their childhoods, causing them to grow up too fast, or sadly not at all." In the worst-affected countries, where life expectancy has plummeted from the mid-60s to the early-30s, turning 18 no longer means reaching adulthood, but rather middle-age. A global campaign designed to strengthen the commitment to the fight against AIDS is crucial, explained Ms. Veneman, because "the scale of this problem is staggering, but the world has been largely unresponsive". "Unite for Children, Unite against AIDS" aims to prevent mother-to-child transmission, provide paediatric treatment, prevent infection among adolescents and young people, and protect and support children affected by HIV/AIDS. It also provides a platform for urgent and sustained programmes, advocacy and fund-raising to limit the impact of the disease on children and help halt its spread. (excerpt)
Adapted for use in former Soviet countries, WHO/US government PMTCT protocols are introduced in three Russian cities.
Connections. 2005 Aug-Sep;  p..HIV/AIDS is called a women's disease in African countries because almost 60 percent of the people infected with the virus are women. This comparison may soon also be relevant for Russia where the relative share of women among people with HIV is rising steadily. In some regions it is already in excess of 40 percent. Russian experts attribute this situation to the development of the commercial sex trade, as well as to a rising rate of transmission through sexual contact with drug users. The gravest situation is the escalating incidence of HIV/AIDS among women of childbearing age, especially those between 15 and 30. More and more cases of the disease are being reported in this group. Many of them are diagnosed during pregnancy, which translates to a corresponding increase the number of HIV-infected children in Russia. At the start of 2005, approximately 10,000 such children had been registered, whereas in 1996 there were only 18 of them. While it is practically impossible to prevent the spread of HIV/AIDS among adults, mother-to-child transmission of the virus can be controlled. The question, "How?" is complex and multifaceted. It was discussed in detail by participants in a series of workshops sponsored by UNICEF and AIHA in three Russian cities-- Magnitogorsk, Orenburg, and Chelyabinsk--between May and August this year. (excerpt)
Connections. 2005 Jun;  p..According to the US Centers for Disease Control and Prevention (CDC), mother-to-child transmission (MTCT) of HIV accounts for nearly 90 percent of the more than 600,000 estimated new HIV infections that occur among children worldwide each year. Without intervention, there is a 15-30 percent risk that an HIV-infected mother will transmit the virus to her child during pregnancy or delivery and an additional 10-20 percent risk of transmission if she breastfeeds. In Central Asia, the actual number of registered HIV/AIDS cases is low in comparison to Russia and Ukraine, although the rate of new infections is increasing at an alarming pace. The reality of the region's epidemic today is that more and more women--particularly those in their reproductive years--are contracting the virus through sexual contact. In Kazakhstan alone, this mode of transmission has increased five-fold within the last four years, threatening the health of future generations. National experts believe that while the epidemic in Central Asia is still in its early stages, prevention of mother-to-child transmission (PMTCT) of the virus should become a key element in their strategy to combat HIV/AIDS. (excerpt)
New York, New York, UNICEF, 2005. 25 p.The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
MCH News. 1998 Jul; (9):5, 9.This statement was released in Geneva on 1 May 1998: In a concerted effort to stop the mother-to-child transmission of HIV, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its co-sponsors the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) have developed a comprehensive set of guidelines that support the use of alternatives to breastfeeding for infants born to women infected with HIV, the virus that causes AIDS. The guidelines are intended to help governments devise national policies to reduce the risk of HIV transmission through breastfeeding and to assist health care managers in providing services and support to this end. The guidelines stress the importance of protecting, promoting and supporting breastfeeding as the best method of feeding for infants whose mothers are HIV-negative or who do not know their HIV status. But at the same time, they recognize the need to support alternatives to breastfeeding for mothers who test positive for the human immunodeficiency virus. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2004.  p.The 2001 report on HIV/AIDS in Asia and the Pacific region published by the WHO Regional Offices for South-East Asia and the Western Pacific presented an overview of the HIV/AIDS pandemic, followed by a description of the general patterns and prevalence of HIV risk behaviours and HIV prevalence trends in the region, as well as in individual countries. This vast geographic region combines the WHO South-East Asia and Western Pacific Regions and contains 60% of the total world population. Thus, even low HIV infection rates in this region will contribute millions of additional people living with HIV/AIDS (PLWHA) and deaths to the already staggering global toll of AIDS. This report provides an update on HIV/AIDS in the region and focuses on the continuing HIV prevalence trends noted in the previous report. It also noted some changes that may be occurring with regard to the public health surveillance and epidemiology of HIV/ AIDS. In addition, the epidemiological patterns of HIV, especially current HIV transmission dynamics, are described for each country. HIV is primarily a sexually transmitted infection (STI) and, as with all STI, the major driving force of the pandemic is heterosexual transmission. Although high rates of HIV infection (50% and higher) have been found and may still occur among injecting drug users (IDU) and men who have sex with men (MSM), more than 90% of the global total of estimated adult infections are due to heterosexual transmission. HIV/AIDS is present at varying prevalence levels in MSM in several regions of the world. Explosive spread of HIV still occurs among IDU populations worldwide and sexual transmission occurs throughout the world in both males and females, especially in those who have unprotected sex with multiple and concurrent partners, such as female sex workers (FSW). Extensive or epidemic heterosexual spread of HIV, affecting 1% or more of the sexually active population, has occurred in sub-Saharan countries, a few countries in the Caribbean and Central America, and a few countries in South and South-east Asia. Considering the presence of risk factors for HIV infection, such as high-risk behaviours and other sexually transmitted infections, and the vulnerability to HIV infection in the region, the major public health question is what actions need to be taken to maintain this low HIV prevalence. However, a response cannot be properly formulated without understanding the HIV epidemic status and trends in the region. (excerpt)
Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.
New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
Geneva, Switzerland, UNAIDS, 2000 Sep. 111 p. (UNAIDS Best Practice Collection; Summary Booklet of Best Practices Series No. 2; UNAIDS/00.34E)AIDS is now the leading killer in sub-Saharan Africa. Whereas 200,000 people died as a result of conflict or war in Africa in 1998, AIDS killed 2.2 million. The progression of the disease has outpaced all projections. In 1991, WHO projected that in 1999 there would be 9 million infected individuals and nearly 5 million cumulative deaths in Africa. The reality in 2000 is two to three times higher, with 34.3 million infected individuals and 18.8 cumulative deaths. Nearly 70 per cent of the world’s HIV infection and 90 per cent of deaths from AIDS are to be found in a region that is home to just 10 per cent of the world’s population. In the sub-Saharan region, infection levels are highest, access to care is lowest, and social and economic safety nets that might help families cope with the impact of the epidemic are badly frayed. Resources are not keeping pace with the challenge. Incidence of the disease is increasing three times faster than the money to control it. Current national AIDS activities in Africa must be expanded dramatically to make an impact on the epidemic. African leaders are demonstrating unprecedented leadership in fighting HIV/AIDS; the time is ripe for an extraordinary effort. The International Partnership against AIDS in Africa (IPAA) is such a mobilization. At the same time, the Best Practice process – accumulating and applying knowledge about what is working and not working in different situations and contexts – is crucial within the framework of the Partnership. (excerpt)
[90 percent cases of HIV transmission are due to perinatal contagion or breastfeeding. One million children were HIV positive in 1977] El 90 por ciento de casos por contagio perinatal o lactancia. Un millon de niños/as portan VIH en 1977.
RedAda. 1997 Dec; (26):22-24.A million children under 15 years of age will have contracted HIV worldwide by 1997, while in 1996, of the one and a half million people who died of this disease, 350,000 were under 15, according to UNAID numbers released on the occasion of the world AIDS campaign (December 1), whose theme this year is "Children in a World with AIDS." Approximately 90 percent of children with HIV were infected by their mothers, during pregnancy or childbirth or through mother's milk, according to the UN organization. (excerpt)
Geneva, Switzerland, WHO, 2004. 2 p.Of the 40 million people living with HIV/AIDS worldwide at the end of 2003, 2.5 million are children under 15 years of age. In 2003 alone, 700,000 children were newly infected with HIV. Most of these infections result from mother-to-child transmission during pregnancy, labour and delivery or through breastfeeding. By integrating a comprehensive prevention of mother-to-child transmission (PMTCT) programme, through prevention and treatment interventions, as an essential part of maternal, child and newborn health programmes, the PMTCT programme can significantly reduce the number of HIV-infected infants and promote better health for children, mothers and their families. Human capacity building at all levels of the health system is one of the big challenges of setting up HIV/AIDS initiative. The rapidly growing HIV/AIDS pandemic requires global and in-country collaborative efforts to maximise the use of existing human resources and develop strengthened human capacity. Globally, up to 100,000 people need to be trained for the "3 by 5" initiative to reach the target. Meeting that training goal will require strong collaboration among communities, nations, and international organisations. This generic PMTCT training package is designed to provide a template for the development of a national training plan and an appropriate national PMTCT curriculum, based on a rapid adaptation process. For countries that already have begun PMTCT training and have draft materials, this generic training package can be used to update and strengthen the national curriculum and training plan. This training package is an evidence-based course on PMTCT and is targeted to resource-constrained settings. (excerpt)
Global AIDSLink. 2004 Aug-Sep; (87):9.The linkages between reproductive health and HIV/AIDS prevention and care must be strengthened in order to achieve internationally agreed development goals. United Nations agencies have initiated a series of consultations to identify ways to build and reinforce these linkages. The Glion Call to Action reflects the consensus of the first consultation in May 2004, which focused on the linkage between family planning and prevention of mother-to-child HIV transmission. The call is set within the context of the objectives and actions agreed at the 1994 Cairo International Conference on Population and Development (ICPD). (excerpt)
Global AIDSLink. 2004 Aug-Sep; (87):16-17.The importance of addressing HIV/AIDS from a stronger sexual and reproductive health and rights perspective has over the past few months been gaining increased global momentum and recognition. Earlier this year, the All Party Parliamentary Group on Population, Development and Reproductive Health in the UK commenced their hearings into the very question of integration: its successes, failures and contextual realities. The Glion Call to Action (see page 8)— released in June — specifically addressed the integration aspects involved in PMTCT programs and policies. And in May, UNFPA hosted a series of technical meetings that aimed to explore some of the broader technicalities of integration. This advocacy document was launched in July at the Bangkok XV International AIDS Conference. Clearly, the question of when, where and how to integrate HIV/AIDS with reproductive health has been plaguing programmers and policy makers, donors and service providers. Answering these questions with meaningful action is not only long overdue but — in the age of increased awareness, and treatment access increasingly becoming a reality — it is unarguably the most unexplored terrain of our international response. For it is only with the concerted effort and coordinated involvement of the sexual and reproductive health community that the lofty Millennium Development Goals; the UN General Assembly's Special Session on HIV/AIDS Commitments; the '3 by 5' targets; and even new modalities of reducing HIV/AIDS-related stigma, will be achieved. The mainstreaming of HIV/AIDS is perhaps not only an untapped avenue, but it also has the potential to awake the full potential of a by-and-large under used resource. Getting there, however, would involve a change in mind-set of all the role players involved. A 'business as usual' approach that does not move beyond rhetoric will have damning consequences. The exceptionality of HIV/AIDS as a largely sexually transmitted infection requires an exceptional response — especially from sexual and reproductive health providers. (excerpt)
New York, New York, Population Council, 2004 Apr. 40 p.Preventing unintended pregnancy among HIV-positive women through family planning services is one of the four cornerstones of a comprehensive program for prevention of mother-to-child HIV transmission (PMTCT). Reducing unintended pregnancies among HIV-positive women through family planning reduces the number of children potentially orphaned when parents die of AIDS-related illnesses. It also reduces HIV-positive women's vulnerability to morbidity and mortality related to pregnancy and lactation. In addition, family planning for both HIV-positive and -negative women safeguards their health by enabling them to space births. The global public health community––NGOs, governments, and international donors–– has mobilized to design and provide essential PMTCT services: voluntary counseling and testing (VCT), infant feeding counseling, outreach to communities and families, and a short course of antiretroviral therapy. In most cases, the implementation approach has been to incorporate PMTCT into services that already reach pregnant women and women of childbearing age: antenatal care, obstetrical care, and maternal/child health. Yet the complexity of introducing PMTCT into the real world—that is, existing health services in resource-poor settings—soon became clear. Population Council and its research partners have been addressing several key questions about PMTCT services and how well they function in field settings. This report reviews field experiences with the integration of family planning and PMTCT services. It is hoped that this review will provide evidence and information for developing effective strategies for appropriately promoting family planning within PMTCT programs. (excerpt)
Are WHO/UNAIDS/UNICEF-recommended replacement milks for infants of HIV-infected mothers appropriate in the South African context?
Bulletin of the World Health Organization. 2004 Mar; 82(3):164-171.Little is known about the nutritional adequacy and feasibility of breastmilk replacement options recommended by WHO/ UNAIDS/UNICEF. The study aim was to explore suitability of the 2001 feeding recommendations for infants of HIV-infected mothers for a rural region in KwaZulu Natal, South Africa specifically with respect to adequacy of micronutrients and essential fatty acids, cost, and preparation times of replacement milks. Nutritional adequacy, cost, and preparation time of home-prepared replacement milks containing powdered full cream milk (PM) and fresh full cream milk (FM) and different micronutrient supplements (2 g UNICEF micronutrient sachet, government supplement routinely available in district public health clinics, and best available liquid paediatric supplement found in local pharmacies) were compared. Costs of locally available ingredients for replacement milk were used to calculate monthly costs for infants aged one, three, and six months. Total monthly costs of ingredients of commercial and home-prepared replacement milks were compared with each other and the average monthly income of domestic or shop workers. Time needed to prepare one feed of replacement milk was simulated. When mixed with water, sugar, and each micronutrient supplement, PM and FM provided <50% of estimated required amounts for vitamins E and C, folic acid, iodine, and selenium and <75% for zinc and pantothenic acid. PM and FM made with UNICEF micronutrient sachets provided 30% adequate intake for niacin. FM prepared with any micronutrient supplement provided no more than 32% vitamin D. All PMs provided more than adequate amounts of vitamin D. Compared with the commercial formula, PM and FM provided 8–60% of vitamins A, E, and C, folic acid, manganese, zinc, and iodine. Preparations of PM and FM provided 11% minimum recommended linoleic acid and 67% minimum recommended a-linolenic acid per 450 ml mixture. It took 21–25 minutes to optimally prepare 120 ml of replacement feed from PM or commercial infant formula and 30–35 minutes for the fresh milk preparation. PM or FM cost approximately 20% of monthly income averaged over the first six months of life; commercial formula cost approximately 32%. No home-prepared replacement milks in South Africa meet all estimated micronutrient and essential fatty acid requirements of infants aged <6 months. Commercial infant formula is the only replacement milk that meets all nutritional needs. Revisions of WHO/UNAIDS/UNICEF HIV and infant feeding course replacement milk options are needed. If replacement milks are to provide total nutrition, preparations should include vegetable oils, such as soybean oil, as a source of linoleic and a-linolenic acids, and additional vitamins and minerals. (author's)
Lancet. 2003 Nov 29; 362(9398):1850-1853.Each year, about 2 million babies are born to HIV-1- infected women. Despite widespread knowledge of proven methods to prevent mother-to-child transmission (MTCT) of the virus, most infants at risk of contracting the infection from their mothers receive no prophylactic intervention. This inaction leads to the infection and ultimate death of about 800 000 children per year. It has been known since 1994 that MTCT is largely preventable, and interventions appropriate for use in the developing world have been available since 1999. Singledose intrapartum and neonatal nevirapine—the simplest and perhaps most effective of the short-course antiretroviral regimens studied—has been available free of charge from the manufacturer since 2000. Nevertheless, few women have access to MTCT-prevention services. In the more than 3 years since its inception, the donation programme has shipped only 189 000 courses of the drug, a tiny fraction (<5%) of the estimate worldwide need. Why this feasible10 and cost-effective intervention has failed to reach so many of the women and infants who need it is a difficult question with no simple answers. Whatever the reasons, we believe that the continued low level of coverage of MTCT-prevention services is no longer acceptable from either a public health or a humanitarian perspective. We argue for a goal-directed approach to scaling-up of such services, in which we first acknowledge that the guiding objective should be to save babies from HIV-1 infection. To meet this objective, it will be necessary in many settings to dissociate the complex business of expanding HIV-1 testing services from the simpler matter of providing nevirapine prophylaxis. (author's)
Geneva, Switzerland, UNAIDS, 2003 Sep. 74 p. (UNAIDS/03.44E)This report provides a snapshot of the action being taken across the African continent in response to the challenge of AIDS. It highlights governments working with all their ministries to deliver a full-scale response. It demonstrates progress in closing the gaps in the provision of HIV prevention and treatment. It shows the value of partnership between government, communities and businesses. It showcases the determination of African women to throw off the disproportionate burden that AIDS represents for them. And it makes manifest the voice of hope, in the many successful responses by young people in fighting the epidemic. (author's)
New York, New York, UNICEF, 2002.  p. (UNICEF Fact Sheet)Approximately one third of infants born to HIV-infected mothers will contract the virus. Without preventive interventions, transmission of the virus occurs during a mother’s pregnancy or during childbirth or breastfeeding. Without interventions, about 15 to 30 per cent of children become infected during pregnancy or delivery; about 10 to 20 per cent contract the virus through breastmilk if breastfed for two years. An estimated 800,000 children under the age of 15 contracted HIV in 2001, about 90 per cent of them through mother-to-child transmission (MTCT). The risks of HIV infection have to be compared with the risks of illness and death faced by infants who are not breastfed. Breastfeeding provides protection from death due to diarrhoea and respiratory and other infections, particularly in the first months of life. During the first two months, a child receiving replacement feeding is nearly six times more likely to die from these infectious diseases, compared to a breastfed child. Breastfeeding also provides complete nutrition, immune factors and the stimulation necessary for good development, and it contributes to birth spacing. (excerpt)
New York, New York, UNICEF, 2002.  p. (UNICEF Fact Sheet)Without preventive interventions, approximately 35 per cent of infants born to HIV-positive mothers contract the virus through mother-to-child transmission. In 2001, 800,000 children under the age of 15 contracted HIV, over 90 per cent of them through mother-to-child transmission. Infants can become infected during pregnancy, childbirth or breastfeeding. Some 15-20 per cent of infant infections occur in pregnancy, 50 per cent occur during labour and delivery, while breastfeeding accounts for a further 33 per cent of infant infections. Sub-Saharan Africa is home to 90 per cent of the world’s HIV infected children. Most of the 580,000 children under the age of 15 who died of HIV/AIDS in 2001 were African. For mothers living with HIV/AIDS, especially in developing countries, the decision on whether or not to breastfeed is a frightening dilemma. Infants not infected during pregnancy and childbirth, whose mothers are HIV positive, face a 10-15 per cent chance of acquiring HIV through breastfeeding, depending on how long they are breastfed. The use of breastmilk substitutes reduces this risk, but can expose them to other dangerous health risks, including diarrhoea. Many mothers in developing countries cannot afford breastmilk substitutes and lack access to clean water, which is essential for their safe preparation and use. A mother living with HIV/AIDS therefore faces many grave difficulties: worries about her own health and survival; the risk of infecting her baby through breastmilk; and the danger that her baby will develop other health problems if she does not breastfeed. (excerpt)