Forthcoming Issue Vol 19 No. 4 Breastfeeding and antiretroviral access among HIV-exposed children during the peak COVID-19 pandemic lockdown, in a rural district, South Africa
Main Article Content
Abstract
Background: There is limited information on whether the period of highest movement restrictions during the COVID-19 pandemic impacted on HIV antiretroviral coverage supporting safe breastfeeding, among HIV-exposed children (HEs).
Objectives: To (i) measure the prevalence of breastfeeding among HEs during peak COVID-19 lockdown (March-June 2020), and (ii) explore its association with antiretroviral coverage and other factors.
Methods: A cross-sectional telephonic survey was conducted (September- to November-2020), among women living with HIV (WLHIV) from rural Ehlanzeni District, South Africa. Data, including child feeding practices, were collected from maternal recall of the COVID-19 pandemic peak lockdown period. Descriptive statistics were conducted, and factors associated with breastfeeding were analyzed using log binomial regression.
Results: A total of 322 WLHIV aged between 19 and 46 years were successfully interviewed. Of these, only 6.4% reported disruption in antiretroviral treatment (ART), 18 (5.6%) had children living with HIV (CLHIV) all on ART. Out of the 300 HIV-exposed uninfected children (HEUs) eligible for postnatal prophylaxis (PNP), 47.7% received it. During the COVID-19 peak lockdown, 30.1% children were breastfed including 28.6% (87/304) of HEUs, and 62.1% of breastfeeding HEUs were on PNP. Log binomial regression analysis showed, HEUs on PNP and CLHIV had increased likelihood of breastfeeding (prevalence ratio (PR) 1.8 (95% confidence interval (CI): 1.2-2.6) and PR 2.6 (95% CI: 1.6-4.4), respectively, compared to eligible HEUs not on PNP.
Conclusion: Good antiretroviral coverage supported safe breastfeeding practices during the COVID-19 peak lockdown, in this rural setting in South Africa, with promising ongoing adoption of extended PNP during breastfeeding.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCH is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. Woldesenbet S, Lombard C, Manda S. The 2019 national antenatal HIV sentinel survey, South Africa. National Department of Health. 2021. https://www.nicd.ac.za/publications/ (accessed 09 April 2025)
2. Vitalis D, Vilar-Compte M, Nyhan K, Pérez-Escamilla R. Breastfeeding inequities in South Africa: can enforcement of the WHO Code help address them? – A systematic scoping review. International Journal for Equity in Health. 2021; 20:114. https://doi.org/10.1186/s12939-021-01441-2
3. Goga AE, Lombard C, Jackson D, et al. Impact of breastfeeding, maternal antiretroviral treatment and health service factors on 18-month vertical transmission of HIV and HIV-free survival: results from a nationally representative HIV-exposed infant cohort, South Africa. J Epidemiol Community Health. 2020;74(12):1069-1077. https://doi.org/10.1136/jech-2019-213453
4. World Health Organization. Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis. Geneva: WHO, 2017. https://www.who.int/publications/i (accessed 09 April 2025)
5. Goga AE, Van de Perre P, Ngandu N, et al. Eliminating HIV transmission through breast milk from women taking antiretroviral drugs. BMJ-British Medical Journal. 2021;374. https://doi.org/10.1136/bmj.n1697
6. Bispo S, Chikhungu L, Rollins N, Siegfried N, Newell ML. Postnatal HIV transmission in breastfed infants of HIV-infected women on ART: a systematic review and meta-analysis. Journal of the International AIDS Society. 2017;20(1). https://doi.org/10.7448/IAS.20.1.21251
7. Goga AE, Lombard C, Jackson D, et al. Impact of breastfeeding, maternal antiretroviral treatment and health service factors on 18-month vertical transmission of HIV and HIV-free survival: results from a nationally representative HIV-exposed infant cohort, South Africa. Journal of Epidemiology and Community Health. 2020;74(12):1069-1077. https://doi.org/10.1136/jech-2019-213453
8. Goga A, Jackson D, Lombard C, et al. Highest risk of mother to child transmission of HIV or death in the first 6 months postpartum: results from 18 month follow-up of an HIV-exposed national cohort, South Africa. Journal of the International AIDS Society; 2016;19: 27-28. https://doi.org/10.7448/IAS.19.6.21264
9. Myer L, Phillips T, McIntyre J, et al. HIV viraemia and mother‐to‐child transmission risk after antiretroviral therapy initiation in pregnancy in Cape Town, South Africa. HIV medicine. 2017;18(2):80-88. https://doi.org/10.1111/hiv.12397
10. South African National Department of Health. Guideline for the prevention of mother to child transmission of communicable infections. NDoH Pretoria; 2019. https://knowledgehub.health.gov.za/ (accessed 09 April 2025)
11. Vrazo AC, Golin R, Fernando NB, et al. Adapting HIV services for pregnant and breastfeeding women, infants, children, adolescents and families in resource‐constrained settings during the COVID‐19 pandemic. Journal of the International AIDS Society. 2020;23(9): e25622. https://doi.org/10.1002/jia2.25622
12. Chappell E, Chimwaza A, Manika N, et al. Impact of the COVID-19 pandemic on the provision and uptake of services for the prevention of mother-to-child transmission of HIV in Zimbabwe. PLOS Glob Public Health. 2023;3(8): e0002296. https://doi.org/10.1371/journal.pgph.0002296
13. Jewell BL, Mudimu E, Stover J, et al. Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple mathematical models. Lancet HIV. 2020;7(9): E629-E640. https://doi.org/10.1016/s2352-3018(20)30211-3
14. He YF, Liu JQ, Hu XD, et al. Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important? Front Pediatr. 2023; 11:1253333. https://doi.org/10.3389/fped.2023.1253333
15. Rollins N, Minckas N, Jehan F, Lodha R, et al. A public health approach for deciding policy on infant feeding and mother–infant contact in the context of COVID-19. Lancet Glob Health. 2021; 9 : e552-e557. https://doi.org/10.1016/s2214-109x(20)30538-6
16. South African National Department of Health. National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults. NDoH Pretoria; 2015. https://knowledgehub.health.gov.za/ (accessed 09 April 2025)
17. Ngoma MS, Misir A, Mutale W, et al. Efficacy of WHO recommendation for continued breastfeeding and maternal cART for prevention of perinatal and postnatal HIV transmission in Zambia. Journal of the International AIDS Society. 2015;18(1):19352. https://doi.org/10.7448/ias.18.1.19352
18. Revheim I, Balthasar MR, Akerkar RR, et al. Trends in the prevalence of breastfeeding up to 6 months of age using structured data from routine child healthcare visits. Acta Paediatrica. 2023;112(1):100-105. http://dx.doi.org/10.1111/apa.16367
19. Nobubelo Ngandu; Thandiwe Mbira, Vundli Ramokolo, et al. Key risk factors for peripartum and postpartum vertical HIV transmission in the context of PMTCT OPTION B+ in a rural district in South Africa.: South African Medical Research Council, 2022. https://www.samrc.ac.za
20. Mukhula VT, Zunza M, Mbira TE, et al. Comparison of infant feeding practices by maternal HIV status, and associated factors, in a rural district, South Africa 2019. International Breastfeeding Journal. 2025;20(1):22. https://doi.org/10.1186/s13006-025-00716-6
21. Ngandu NK, Lombard CJ, Mbira TE, et al. HIV viral load non-suppression and associated factors among pregnant and postpartum women in rural northeastern South Africa: a cross-sectional survey. BMJ-British Medical Journal. 2022;12(3):e058347. https://doi.org/10.1136/bmjopen-2021-058347
22. Ansha MG, Kuti KA, Tasew ST. Infant feeding practice and associated factors among HIV positive mothers at health institution of Shashemene Town, South Ethiopia. J Family Reprod Health. 2020;14(2):124-130. https://doi.org/10.18502/jfrh.v14i2.4357
23. West NS, Schwartz SR, Yende N, et al. Infant feeding by South African mothers living with HIV: implications for future training of health care workers and the need for consistent counseling. International Breastfeeding Journal. 2019;14(1). http://dx.doi.org/10.1186/s13006-019-0205-1
24. Oiye S, Mwanda W, Mugambi M, Filteau S, Owino V. Exclusive breastfeeding is more common among HIV-infected than HIV-uninfected Kenyan mothers at 6 weeks and 6 months postpartum. Breastfeed Med. 2017; 12:283-289. https://doi.org/10.1089/bfm.2016.0126
25. van der Berg S, Patel L, Bridgman G. Food insecurity in South Africa: Evidence from NIDS-CRAM wave 5. Development Southern Africa. 2022;39(5):722-737. https://doi.org/10.1080/0376835X.2022.2062299
25. De Wet-Billings N. Perpetuation of household food insecurity during COVID-19 in South Africa. Journal of Health, Population and Nutrition. 2023;42(1):96. https://doi.org/10.1186/s41043-023-00441-y
27. Kankasa C, Mennecier A, Sakana BLD, et al. Optimised prevention of postnatal HIV transmission in Zambia and Burkina Faso (PROMISE-EPI): a phase 3, open-label, randomised controlled trial. Lancet. 2024 Apr 6;403(10434):1362-1371. https://doi.org/10.1016/S0140-6736(23)02464-9