AEGiS-14IAC: Uptake of interventions to reduce mother-to-child HIV transmission: nevirapine and exclusive breastfeeding in the Zambia exclusive breastfeeding study (ZEBS).

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Uptake of interventions to reduce mother-to-child HIV transmission: nevirapine and exclusive breastfeeding in the Zambia exclusive breastfeeding study (ZEBS).

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. TuOrB1176)

Kuhn L, Kasonde P, Vwalika C, Shutes E, Sinkala M, Kankasa C, Aldrovandi G, Piwoz E, Thea DM
Columbia University, New York, United States

BACKGROUND: ZEBS, a clinical trial in Lusaka, Zambia, seeks to determine if short exclusive breastfeeding (EBF) can reduce breastfeeding-associated HIV transmission and infant mortality. Important to the study is adherence to counsellors' advice to breastfeed exclusively.

METHODS: All pregnant woman attending antenatal care at two District Health Clinics in Lusaka, Zambia are offered VTC and, if HIV+, are counselled about Nevaripine (NVP) to prevent transmission and given the tablet. Counselling to support EBF begins antenatally, initiation of breastfeeding is supported at delivery, and post-natal counselling at the clinic and at home continues through the post-natal period. Detailed information is collected using standardized interviews, counsellors' reports, diaries and home observations. Participants are seen 2x during the first week, 1x per week until 1 month, and every 2 weeks until 6 months.

RESULTS: To date, 217 HIV+ women have been enrolled (mean age 24 yrs and median CD4 count 350). 100 women have delivered live-born infants and 87 took NVP, including 6/9 women who delivered at home. 90 infants received NVP, including 7/9 born at home who received their dose w/in 2 days of birth at the clinic. EBF was initiated within a median of 30 min after birth. Between birth and 1 wk, 86% of infants consumed only breastmilk and <4% received non-breastmilk options on more than a single, isolated occasion. Counting anything, even if only given once, except prescribed medicines, between 1 week and 1 month, 95% consumed only breastmilk, between 1-2 months 91%, 2-3 months 87% and 3-4 months 84%. Only 39% reported EBF their prior child.

CONCLUSION: A modest program to support interventions to reduce mother-to-child HIV transmission appears to be able to achieve good adherence to both the NVP regimen and to EBF. Attention to the training and support of health care workers and peer educators who form part of the team is essential.

Keywords: AEGIS, Nevirapine, Breast Feeding, HIV Infections, Mothers, HIV Seropositivity, Counseling, Infant Nutrition, Zambia, Child, Infant, Human, Female, Pregnancy, transmission, nursing

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TuOrB1176