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Acceptability of Exclusive Breast-Feeding With Early Cessation to Prevent HIV Transmission Through Breast Milk, ANRS 1201/1202 Ditrame Plus, Abidjan, Côte d'Ivoire

Becquet, Renaud MPH*; Ekouevi, Didier K MD, PhD; Viho, Ida MD; Sakarovitch, Charlotte MSc*; Toure, Hassan MD; Castetbon, Katia PhD; Coulibaly, Nacoumba MD; Timite-Konan, Marguerite MD§; Bequet, Laurence MD; Dabis, François MD, PhD*; Leroy, Valériane MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2005 - Volume 40 - Issue 5 - p 600-608
doi: 10.1097/01.qai.0000171726.17436.82
Epidemiology and Social Science

Objective: We assessed the uptake of a nutritional intervention promoting exclusive breast-feeding with early cessation between 3 and 4 months of age to reduce postnatal transmission of HIV in Abidjan, Côte d'Ivoire.

Design: Between March 2001 and March 2003, HIV-infected pregnant women who had received perinatal antiretroviral prophylaxis were systematically offered prenatally 2 infant feeding interventions: artificial feeding or exclusive breast-feeding during 3 months and then early cessation of breast-feeding. Mother-infant pairs were closely followed for a period of 2 years, with continuous nutritional counseling and detailed collection of feeding practices.

Results: Among the 557 mothers enrolled, 262 (47%) initiated breast-feeding. Of these women, the probability of practicing exclusive breast-feeding from birth was 18% and 10% at 1 and 3 months of age, respectively. Complete cessation of breast-feeding was obtained in 45% and 63% by 4 and 6 months of age, respectively. Environmental factors such as living with a partner's family were associated with failure to initiate early cessation of breast-feeding.

Conclusions: Acceptability of exclusive breast-feeding was low in this urban population. Shortening the duration of breast-feeding seemed to be feasible, however. Further investigations are ongoing to evaluate the safety and effectiveness of this intervention in reducing breast milk HIV transmission.

From *Unité INSERM 593, Institut de Santé Publique Epidémiologie Développement (ISPED), Université Victor Segalen, Bordeaux, France; †Projet ANRS Ditrame Plus, Programme PAC-CI, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire; ‡Unité de Surveillance et d'Epidémiologie Nutritionnelles, Institut National de la Veille Sanitaire (InVS), Conservatoire National des Arts et Métiers, Paris, France; and §Service de Pédiatrie, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire.

Received for publication December 22, 2004; accepted May 17, 2005.

The primary sponsor of the ANRS 1201/1202 Ditrame Plus study was the Agence Nationale de Recherches sur le SIDA (ANRS). R. Becquet was a fellow of the French Ministry of Education, Research, and Technology. Didier K. Ekouevi was a fellow of the French charity “Ensemble contre le SIDA.” Laurence Bequet was supported by the French Ministry of Foreign Affairs.

Presented in part at the 15th International AIDS Conference, July 11-16, 2004, Bangkok, Thailand.

Reprints: Renaud Becquet, Unité INSERM 593, Institut de Santé Publique Epidémiologie Développement, Université Victor Segalen Bordeaux 2, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France (e-mail: Renaud.Becquet@isped.u-bordeaux2.fr).

© 2005 Lippincott Williams & Wilkins, Inc.