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Feasibility of Using Flash-Heated Breastmilk as an Infant Feeding Option for HIV-Exposed, Uninfected Infants after 6 Months of Age in Urban Tanzania

Chantry, Caroline J. MD*; Young, Sera L. PhD*; Rennie, Waverly MPH; Ngonyani, Monica RN; Mashio, Clara; Israel-Ballard, Kiersten DrPH; Peerson, Janet MS§; Nyambo, Margaret MD; Matee, Mecky MD, PhD; Ash, Deborah PhD; Dewey, Kathryn PhD§; Koniz-Booher, Peggy DrPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1st, 2012 - Volume 60 - Issue 1 - p 43–50
doi: 10.1097/QAI.0b013e31824fc06e
Clinical Science

Objective: Heat-treating expressed breastmilk is recommended as an interim feeding strategy for HIV-exposed infants in resource-poor countries, but data on its feasibility are minimal. Flash-heating (FH) is a simple in-home technique for heating breastmilk that inactivates HIV although preserving its nutritional and anti-infective properties. Our primary objective was to determine, among HIV-infected mothers, the feasibility and protocol adherence of FH expressed breastmilk after 6 months of exclusive breastfeeding.

Design: Prospective longitudinal.

Participants: One hundred one HIV-infected breastfeeding mothers

Setting: Dar es Salaam, Tanzania

Intervention: Peer counselors provided in-home counseling and support on infant feeding from 2 to 9 months postpartum. Mothers were encouraged to exclusively breastfeed for 6 months followed by FH expressed breastmilk if her infant was HIV negative. Clinic-based staff measured infant growth and morbidity monthly, and mothers kept daily logs of infant morbidity. FH behavior was tracked until 9 months postpartum using daily logs, in-home observations, and clinic-based and home-based surveys. Bacterial cultures of unheated and heated milk samples were performed.

Results: Thirty-seven of 72 eligible mothers (51.4%) chose to flash-heat. Median (range) frequency of milk expression was 3 (1–6) times daily and duration of method use on-study was 9.7 (0.1–15.6) weeks. Mean (SD) daily milk volume was 322 (201) mL (range 25–1120). No heated and 32 (30.5%) unheated samples contained bacterial pathogens.

Conclusions: FH is a simple technology that many HIV-positive women can successfully use after exclusive breastfeeding to continue to provide the benefits of breastmilk while avoiding maternal-to-child transmission associated with nonexclusive breastfeeding. Based on these feasibility data, a clinical trial of the effects of FH breastmilk on infant health outcomes is warranted.

*Department of Pediatrics, University California Davis Medical Center, Sacramento, CA

University Research Company, Dar es Salaam, Tanzania

PATH, Seattle, WA

§Department of Nutrition, University of California Davis, Davis, CA

Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

FH1360, FANTA-3, Dar es Salaam, Tanzania.

Correspondence to: Caroline J. Chantry, MD, Department of Pediatrics, University of California Davis Medical Center, 2516 Stockton Blvd., Sacramento, CA 95817 (e-mail:

This study was funded by the National Institutes of Health (NIH R01HD057602) and the Thrasher Research Fund.

The authors have no conflicts of interest to disclose.

Received August 25, 2011

Accepted February 10, 2012

© 2012 Lippincott Williams & Wilkins, Inc.