Survival of Infants Born to HIV-Positive Mothers, by Feeding Modality, in Rakai, Uganda

Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda.One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%–29%) among the formula-fed compared to 3% (95% CI = 1%–9%) among the breast-fed infants (unadjusted hazard ratio (HR)  = 6.1(95% CI = 1.7–21.4, P-value<0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67–11.7, P-value = 0.16]Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings

Emploi des services liés au VIH et à la contraception moderne chez les femmes en âge de procréer, Rakai, Uganda.

Voluntary counseling and testing (VCT) and HIV care (HIVC) can be an opportunity for reproductive health messages and services integration. The objective of this study is to assess the association between uptake of HIV-related services and use of modern contraception among reproductive-age women. Data are derived from community cohort data, where HIV+ respondents were referred to the Rakai Health Sciences program&apos;s HIVC clinic. Use of modern contraceptive and VCT receipt were by self-report. Multinomial logistic regression was used to estimate relative risk ratios (RRR) of contraception use by HIVC and VCT. Receipt of VCT was significantly associated with higher use of condoms for FP, adj.RRR 1.78 (1.07, 2.95), and other modern contraceptives, adj.RRR=1.56(1.15, 2.11). Increasing level of HIVC was associated with decreasing level of unmet need for contraception. Use of condoms for family planning is common among HIV-related services attendees. Utilization of other modern contraceptive methods needs to be increasedLe Conseil et le Test Volontaire (CTV) et le soin du VIH (SVIH) peuvent constituer une opportunité pour des messages de santé de reproduction et d&apos;intégration des services. Cette étude a pour objectif d&apos;évaluer l&apos;association entre l&apos;intérêt aux services liés aux VIH et l&apos;emploi de la contraception chez les femmes en âge de procréer. Les données ont été recueillies à partir des données de la cohorte de la communauté, là où les répondantes séropositives ont été orientées vers la clinique du SVIH du programme des Sciences de Santé de Rakai. L&apos;emploi du contraceptif et du CTV était à travers l&apos;auto-déclaration. On s&apos;est servi de la régression logistique multinomiale pour évaluer le rapport du risque relatif (RRR) de l&apos;utilisation de la contraception par le SVIH et le CTV. La réception du CTV est liéé à l&apos;emploi élevé des préservatifs pour la PF, l&apos;adj.RRR=1,78, 2,95) et d&apos;autres contraceptifs modernes, adj. RRR=1,56(1,15, 2,11). Le niveau croissant du SVIH était lié au niveau diminuant des besoins non satisfait de la contraception. L&apos;emploi des contraceptifs pour la planification familiale est commun chez les gens qui profitent des services liés au VIH. Il faut augmenter l&apos;emploi des autres méthodes contraceptives moderne

Mobility among youth in Rakai, Uganda: Trends, characteristics, and associations with behavioural risk factors for HIV

Mobility, including migration and travel, influences risk of HIV. This study examined time trends and characteristics among mobile youth (15–24 years) in rural Uganda, and the relationship between mobility and risk factors for HIV. We used data from an annual household census and population-based cohort study in the Rakai district, Uganda. Data on in-migration and out-migration were collected among youth (15–24 years) from 43 communities from 1999 to 2011 (N = 112,117 observations) and travel among youth residents from 2003 to 2008 (N = 18,318 observations). Migration and travel were more common among young women than young men. One in five youth reported out-migration. Over time, out-migration increased among youth and in-migration remained largely stable. Primary reasons for migration included work, living with friends or family, and marriage. Recent travel within Uganda was common and increased slightly over time in teen women (15–19 years old), and young adult men and women (20–24 years old). Mobile youth were more likely to report HIV-risk behaviours including: alcohol use, sexual experience, multiple partners, and inconsistent condom use. Our findings suggest that among rural Ugandan youth, mobility is increasingly common and associated with HIV-risk factors. Knowledge of patterns and characteristics of a young, high-risk mobile population has important implications for HIV interventions

Kaplan-Meier cumulative probabilities of survival from death by feeding group.

<p>Actual visits grouped by the three scheduled visits at one, six and twelve months after birth.</p

Consort diagram showing follow-up of infants, losses to follow-up, deaths and HIV-infection.

<p>* Includes one new HIV-infection observed at six months for an infant who was not tested at one month. † Infection occurred by one month. Failure to be tested was a result of refusal by the mothers to have their babies tested and a minority of cases it was due to insufficiency of the infant sample.</p

Baseline Maternal and Infant Characteristics.

*<p>Safe water source defined to include boreholes, protected spring or tap water.</p>**<p>61 missing baseline CD4 count</p

Kaplan-Meier cumulative probabilities of HIV-free survival by feeding group.

<p>Actual visits grouped by the three scheduled visits at one month, six months and twelve months after birth. *Adjusted for maternal age and maternal antiretroviral therapy. ** Twenty five observations left-censored for the following reasons: 12 babies were HIV-positive at one month without HIV results at birth, 9 were not tested for HIV at one month, and 4 losses to follow-up. † Three infants who were HIV-positive at one month were left-censored.</p