Background: Breastfeeding is associated with significant reductions in infant mortality rates in
developing country settings, and the World Health Organization recommends exclusive breastfeeding
(EBF) for 6 months when possible. Where HIV-infected mothers receive anti-retroviral treatment (ART), it
is recommended that they also practice EBF. However, exclusive breastfeeding rates remain low
throughout Sub-Saharan Africa, irrespective of maternal HIV status. Counseling interventions have been
demonstrated to increase EBF rates in a variety of settings, but few studies have designed and evaluated
interventions for HIV-infected women in sub-Saharan Africa.
Methods: HIV-positive pregnant women reporting for care at six government health facilities in Nairobi
were enrolled into a before-after study. The first cohort of women at each clinic received standard
perinatal care and the second group was offered standard care plus three sessions of lactation
counseling sessions promoting exclusive breastfeeding for prevention of mother-to-child HIV-1
transmission (PMTCT). Subjects were followed until 14 weeks after delivery, and infants were tested for
HIV at six weeks postpartum. The proportion of women practicing EBF at fourteen weeks postpartum was
compared between control and intervention groups using binomial regression. Other outcomes included
6-week HIV-free survival, 14-week infant survival, and counts of breast pathology from 0 to 14 weeks
postpartum.
Results: Eight hundred thirty-three women were enrolled into the study between 2009 and 2013. Median
age was 27 years (Interquartile range [IQR] 23-31 yeas), and median CD4 count was 403 cells/L (IQR
287-571). The proportion of women practicing EBF at 14 weeks postpartum was high in both groups
(>80%) and there was no significant difference between treatment and control group (p>0.05). No
differences were observed between groups for 6-week HIV-free survival, 14-week infant survival, or
prevalence of breast pathology.
Conclusion: The counseling intervention was not associated with increased EBF. However, the
proportion of women practicing EBF, irrespective of study arm, was nearly two times higher than the
proportion reported nationally in 2008. High rates of EBF in the study population may be attributable to
policy changes and a strong national PMTCT program.