Predictors of early breastfeeding cessation among HIV-infected women in Botswana

Objective: Infants born to HIV-infected women receiving antiretroviral treatment (ART) can be breastfed through at least 6 months with very low risk of HIV acquisition. We aimed to identify demographic and cultural factors that may influence mothers' willingness to breastfeed for the recommended duration. Methods: We evaluated factors associated with early cessation of breastfeeding (i.e. before 5 months post-partum) in a randomized clinical trial evaluating different ART regimens used for prevention of mother-to-child transmission during breastfeeding in Botswana. Univariate and multivariable Cox regressions were used to describe predictors of early exclusive BF cessation. Results: Among 677 women who started breastfeeding, the median time to breastfeeding cessation was 178 days (IQR 150–181) and 25.1% weaned early. In multivariable analysis, urban location (aHR = 1.86 95%CI 1.27–2.73; P = 0.002), salaried employment or being a student (aHR = 2.78 95% CI 1.63–4.75; P < 0.001) and infant hospitalisation before weaning (aHR = 2.04 95% CI 1.21–3.45; P = 0.008) were independently and significantly associated with early BF cessation. Conclusions: Improved support for breastfeeding among employed mothers, especially in urban settings, may allow HIV-infected women who are receiving ART prophylaxis to breastfeed longer.