What Works for Women and Girls

during breastfeeding compared with women with CD4 cell counts over 500 cells/ul,confirming the findings of other studies that postnatal transmission of HIV is highlycorrelated with immune suppression in the mother (Illiff et al., 2005). (Gray II) (breastfeeding,PMTCT, infant feeding, Zimbabwe)A study in Nigeria, which screened pregnant women for HIV-1 between 2004 and 2006,found that risk factors for mother-to-child transmission of HIV-1 differed by infant age.Infants at highest risk of acquiring HIV were those who had mothers with CD4 countsless than 200 and who received mixed feeding. The study analyzed 391 mothers and371 infants, using follow-up visits 1 week after delivery and 1, 3, 6, and 12 months afterdelivery. A single-dose of nevirapine was given to each mother during delivery and toher infant within 48 hours of delivery. Women who chose replacement feeding wereprovided a 6-month supply of formula free of charge, as well as training and counselingon formula preparation, sterilization, and storage processes. Mothers who chose exclusivebreastfeeding were provided counseling on the importance of weaning before 4–6months. Exclusive breastfeeding was defined as only breast milk up until 6 months,with no other liquids or solids; replacement feeding as the use of formula only with nobreast milk; and mixed feeding as a combination of breast milk and nonhuman milkor other solids before 6 months of age. For infants who were exclusively breastfed,8.1% tested HIV-positive by 6-months of age compared to 9.5% of infants exclusivelyformula fed, and 29.2% of infants who received mixed feeding. After delivery, 71.7%of mothers chose replacement feeding while 28.3% chose to exclusively breastfeed. At6-month follow-up, 71.1% of mothers who initially chose to breastfeed reported maintainingexclusive breastfeeding, 80.2% of mothers who initially chose formula feedingreported exclusive replacement feeding, and 82 mothers reported using mixed feeding.During the study period, 50 infants became infected with HIV-1, 34% in utero, 30%intrapartum or early postnatally, and 36% postnatally, with an overall transmissionrate of 13.5%. For infants infected in utero, risk factors included maternal CD4 countof less than 200 and high maternal viral load. For infants infected during the intrapartumor early postnatal period, risk factors included high maternal viral load, gestationalage of less than 37 weeks, and prolonged membrane rupture during delivery.Infants infected during the intrapartum or early postnatal period were at higher riskif they received mixed feeding compared to infants who were exclusively formula orbreast-fed (12% compared to 2.2%). For infants infected during the postnatal period,mixed feeding and low birth weight increased the risk of HIV transmission. The riskof transmission for infants who were exclusively breastfed increased from 1.4% duringthe intrapartum/early postnatal period to 4.2% postnatally. The rate of transmissionduring all three infant-age periods for infants who were exclusively formula fed wassimilar. For mothers who initially chose to replacement feed but then switch to mixedfeeding, stigma, pressure from family members, and no partner support were reportedas reasons for not maintaining exclusive formula feeding (Charurat et al., 2009). (GrayIII) (PMTCT, breastfeeding, infant feeding, mixed feeding, Nigeria)WHAT WORKS FOR WOMEN AND GIRLS261