Feasibility of Flash-heating human milk to reduce maternal to child HIV transmission

Background: WHO recommends HIV+ mothers exclusively breastfeed (EBF) for 6 months unless replacement feeding is acceptable, feasible, affordable, sustainable and safe, and continue to breastfeed for a full year. Risk of HIV transmission through breastfeeding increases during mixed feeding, but may be lowered by breastmilk pasteurization. Flash-heating (FH) is a simple method of home pasteurization that inactivates HIV and preserves breastmilk's nutritional and anti-infective properties. Our objective was to examine feasibility of FH. Methods: In this prospective study, peer counselors visited 93 HIV(+) mothers in Dar es Salaam, Tanzania weekly from 2-9 mos postpartum. They counseled mothers on FH of expressed breastmilk if infant was HIV(-) at introduction of complementary foods. Participants were surveyed weekly about infant feeding practices, including Flash-heating behaviors. Unheated and heated milk samples were collected biweekly for bacterial and viral tests. Results: 47 of 63 (74.6%) eligible mothers with HIV(-) infants chose to FH. Mean (sd) duration of use 58.3(37.2) days. 4 mothers continued FH after study termination (9 mos postpartum). Mean frequency of manual expression was 2.8(1.2) times daily. Mean daily milk volume was 311(261)mL with the range 34-986 mL. 23 of 73 (32%)unheated milk samples and no heated samples contained pathogens. Conclusions: FH is a simple technology for reducing MTCT-HIV that women can successfully use to improve their infant's diet after cessation of breastfeeding or during other high risk times, such as unavailability of ARVs or mastitis. Based on these data, a clinical trial of FH on infant health outcomes is warranted.