Breastfeeding practices among women living with HIV who started antiretroviral therapy in pregnancy in Cape Town South Africa

Nqeto, Kanyo Naledi

Breastfeeding practices among women living with HIV who started antiretroviral therapy in pregnancy in Cape Town South Africa

Thesis / Dissertation

2023

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Mental illness as a determinant of non-adherence to breastfeeding recommendations among women living with Human Immunodeficiency Virus (HIV) remains an understudied phenomenon in low- and middle-income countries like South Africa. Our aim was to investigate the relationship between postpartum women living with HIV experiencing mental illness and adherence to breastfeeding practices as per the World Health Organization standards (WHO) in Cape Town, South Africa. Methods A secondary analysis was performed on data from 411 women living with HIV (WLHIV) who initiated ART in pregnancy. The women had participated in the 2016 – 2018 Postpartum Adherence Clubs for Antiretroviral Therapy (PACART) trial, which compared viral suppression up to 24 months postpartum in women randomized to two different models of HIV care. All 411 women were examined for the incidence of breastfeeding initiation and its association with postnatal depression using a bivariate analysis and a log-binomial regression. We also examined factors associated with breastfeeding duration and compared this duration in women at high risk of depression and those who were at low risk, using the cox proportion hazard model, Kaplan-Meier curves and the log rank test. Breastfeeding practices were assessed through an administered questionnaire and the Edinburgh postnatal depression scale had been used to identify the risk of depression. All women in the PACART trial were eligible for our study. Results A large proportion of mothers initiated breastfeeding within 72 hours postpartum, and this was similar among those with an increased risk of postnatal depression (n=99; 96.1%) and those with a decreased risk of postnatal depression (n=300; 97.4%). No significant factors were found that were associated with breastfeeding. Breastfeeding duration was similar in women at high risk of postnatal depression (91 days; interquartile range [IQR] 30 – 180) and those at low risk of postnatal depression (90 days; IQR 1 – 180), and this was not statistically significant (p-value = 0.69). Furthermore, we found no factors associated with breastfeeding duration. Conclusion We found no association between risk of postnatal depression and breastfeeding among women living with HIV initiating ART in pregnancy. Though breastfeeding initiation was at an optimal level, the duration was short indicating non-adherence to WHO standards. More effort needs to be made to address breastfeeding non-adhere

Keywords

Medicine

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