Overview

WHO guidelines on HIV and Infant Feeding in 2010 for the first time recommended the use of antiretroviral drugs to prevent postnatal transmission of HIV through breastfeeding. This resulted in a major change from an individualised counselling approach toward a public health approach regarding how maternal and child health services should routinely promote and support infant feeding practices among mothers living with HIV.

Since then, almost all countries prioritised in the UNAIDS ‘Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive’ have adopted the approach of promoting and supporting breastfeeding and the provision of lifelong antiretroviral treatment as the strategy to optimise HIV-free survival among HIV-exposed, uninfected infants and children.

Since 2010, a number of questions have arisen following implementation of the recommendations at country level. These questions were identified during a guideline scoping meeting convened at UNICEF in New York, November 2014. The following questions were prioritised and are addressed in the updated guideline.

• For how long should a mother living with HIV breastfeed if she is receiving ART and there is no evidence of clinical, immune or viral failure?
• Can facility- and community-based interventions improve the quality of infant feeding practices among mothers living with HIV?
• If a mother living with HIV does not exclusively breastfeed, is mixed feeding with ART better than no breastfeeding at all
• If a mother living with HIV plans to return to work or school, is a shorter duration of planned breastfeeding with ART better than no breastfeeding at all?

The 2016 guidelines provide two Recommendations and two Guiding Practice Statements addressing these four questions. In addition, the guidelines comment on the implications for:

1. routine monitoring and evaluation and also
2. conflict and emergency settings.

Contents

• Abbreviations and acronyms
• Definitions and key terms
• Acknowledgements
• Executive summary
• Scope and purpose
• The 2010 WHO principles and recommendations on HIV and infant feeding: valid and updated
• Background
  • Target audience
  • Population of interest
  • Priority questions for review
• Evidence and recommendations
  • 1 The duration of breastfeeding by mothers living with HIV
  • 2 Interventions to support infant feeding practices by mothers living with HIV
  • 3 What to advise when mothers living with HIV do not exclusively breastfeed
  • 4 What to advise when mothers living with HIV do not plan to breastfeed for 12 months
• Implications for monitoring and evaluation
• Implications for conflict and emergency settings
  • Next steps
• Methods
  • Evidence retrieval, assessment and synthesis
  • WHO Steering Committee
  • Guideline Development Group
  • External Peer Review Group
  • Managing conflicts of interest
  • Grading the quality of the evidence
  • Decision-making process
• Dissemination, adaptation and implementation
  • Dissemination
  • Adaptation and implementation
  • Monitoring and evaluating the implementation of the guideline
  • Implications for future research
  • Plans for updating the guideline
• References
• Annex 1 Systematic reviews including GRADE tables related to the duration of breastfeeding by mothers living with HIV
• Annex 2 Systematic reviews including GRADE tables related to interventions to improve infant feeding practices by mothers living with HIV
• Annex 3 Survey of national health authorities in the 22 priority countries for the Global Plan
• Annex 4 Guideline Development Group and advisory groups
• Annex 5 Questions and PICO used as the basis for preparing systematic reviews of the available published evidence

Suggested citation:

World Health Organization, United Nations Children's Fund. Guideline: updates on HIV and infant feeding: the duration of breastfeeding, and support from health services to improve feeding practices among mothers living with HIV. Geneva: World Health Organization; 2016.

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