HIV-free survival among breastfed infants born to HIV-positive women in post-conflict northern Uganda: a perspective from two tertiary health facilities

Background Without interventions, the risk of mother-to-child transmission of HIV is up to 25% during pregnancy, labour and delivery with an additional risk of 5-20% during breastfeeding period, leading to an overall rate of up to 45%. Giving anti-retroviral therapy to the mother and anti-retroviral prophylaxis to the infant has been shown to significantly reduce the risk of HIV transmission through breastfeeding to less than 5%. According to the World Health Organization standard, the effectiveness of interventions towards prevention of mother-to-child transmission of HIV in any setting is measured by its HIV-free survival rate. We therefore carried out a study aimed at determining the HIV-free survival among breastfed infants in a resource poor setting in relation breastfeeding duration. Methods A cross-sectional retrospective study using routine clinical data and involving 365 HIV exposed infants followed up in two tertiary facilities in northern Uganda between 2014 and 2016. Data was analysed using Statistical Package for Social Scientists version 16 software package. Results Of the three hundred and sixty five (365) infants sampled for this study, 86.8% (317/365) were enrolled within the first 2 months of life, 12.1% (44/365) between 3-12 months of age and 1.1% (4/365) enrolled after 12 months of age. Almost all the infants (98.4%) were initiated on Nevirapine prophylaxis, 97.5% (356/365) of whom were initiated within 72 hours. The overall HIV-free survival rate in the current study was 93.7% (342/365), while 6.3% (23/365) were either HIV-infected (2.7%) or died (3.6%). The infants’ age at enrolment was the single most important factor significantly associated with HIV-free survival. The overall duration of breastfeeding did not significantly affect the HIV-free survival: 98.1% (304/310) for children breastfed > 12 months versus 100% (15/15) for those breastfed ≤12 months, though exclusive breastfeeding for at least 6 months was protective. Conclusions Adherence to current approaches to prevention of mother-to-child transmission of HIV with support to breastfeeding in low income countries can greatly enhance HIV-free survival for breastfed infants, and supports the current infant and young child feeding recommendations. Key words: HIV-free survival, Mother-to-child transmission, Breastfeeding, Antiretroviral therapy