PMTCT hailed for reduced HIV transmission
Patricia Edwin | Wednesday September 10, 2014 12:50
PMTCT Programme Officer at Centre for Disease Control Botswana (CDC) Dr Janet Mwambona also said that PMTCT has reduced deaths among HIV-exposed infants in the first year of their lives.
She was speaking on issues of breastfeeding at the New Directions In Global Health workshop that was held in Sowa Town last week.
Mwambona further said that breast milk saves lives of newborn babies as compared to mixed and replacement feeding.
She said that in PMTCT proportion breastfeeding increased from 3.2 percent in 2007 to 11.5 percent in 2012.
“In general less than 25 percent of mothers breast feed from zero to four months while about 37 percent continue to breastfeed till 12 to 15 months,” she said.
She went on to say that the government recommends that HIV infected women for whom formula feeding is not acceptable, feasible, affordable or sustainable and safe (AFASS) should exclusively breastfeed for the first six months of life, while continuing Anti-Retroviral Therapy (ART).
“And if formula feeding is accessible, feasible, affordable, sustainable and safe then exclusive formula feeding for the first six months is recommended and continue formula feeding until 12 months of age. Start complimentary food at six months,” she said.
Mwambona said that mothers of HIV infected infants are strongly encouraged to breastfeed because survival at 24 months has been seen to be higher in continued breastfeeding as compared to those who stopped early.
The doctor also said that while formula milk has been found to be more effective in preventing mother-to-child transmission of HIV, mortality and malnutrition rates are higher than that of breastfed babies. “Mortality is reportedly higher among those on formula due to diarrhoea and malnutrition,” she said. She said that the risk of acquiring HIV through breast milk with ARVs has significantly been reduced while risk of death from other causes other than HIV is increased if there is no breastfeeding. She also said that they have experienced difficulties in implementing AFASS criteria in Botswana that sometimes formula is out of stock resulting in mixed feeding, which is even more dangerous to infants. Mwambona said that the other factor proving hard to change is that women were for several years taught that formula feeding is safe.
“Years of formula feeding messages for infected pregnant women are difficult to change,” she said.
Mwambona also touched on the Option B+ programme, which recommends the use of lifelong ARV treatment for any pregnant women who is HIV positive regardless of their CD4 count. She said that the World Health Organisation (WHO) in their recent guidelines recommended this but Botswana has used this option since 2011.
“It is where ARV treatment is given to HIV positive pregnant women with a CD4 count of less than 350 and lifelong ARV treatment is given to those with a CD4 count of more than 350,” she said.
She added that the benefits of Option B+ were that there was no limit for the duration of breastfeeding, and there is potential benefit to the uninfected partner. Also there is simplification of the public health message, ‘ART is for life’ and the use of the same regimen ATRIPLA for general ART treatment and PMTCT.
“Botswana is considering to adopt Option B+ and this move will align Botswana’s programme with 2013 WHO recommendations,” she said.