Breastfeeding and antiretroviral access among HIV-exposed children during the peak COVID-19 pandemic lockdown in a rural district in South Africa

Background. There is limited information on whether the period of highest movement restrictions during the COVID-19 pandemic impacted on antiretroviral coverage for supporting safe breastfeeding among HIV-exposed children. Objectives. To (i) measure the prevalence of breastfeeding among HIV-exposed children during peak COVID-19 lockdown (March - June 2020); and (ii) explore its association with antiretroviral coverage and other factors. Methods. A cross-sectional telephonic survey was conducted (September to November 2020), among women living with HIV (WLHIV) from rural Ehlanzeni District, South Africa (SA). Participants who were previously enrolled in a face-to-face study during 2019 and who provided consent for future studies, were invited to take part in the present survey. Data, including child feeding practices, were collected from maternal recall of the COVID-19 pandemic peak lockdown period. Descriptive statistics were calculated and factors associated with breastfeeding were analysed using log binomial regression. Results. A total of 322 WLHIV aged between 19 and 46 years were successfully interviewed. Of these, only 6.4% reported disruption in antiretroviral treatment (ART), 18 (5.6%) had children living with HIV (CLHIV), all of whom were on ART. Out of the 300 HIV-exposed uninfected children (HEUs) who were eligible for extended postnatal prophylaxis (extended PNP) (those still breastfeeding, and the mother either had a viral load (VL) ≥1 000 copies/mL or had not undergone VL testing within the past 6 months), 47.7% received it. During the COVID-19 peak lockdown, 30.1% of children were breastfed, including 28.6% (n/N=87/304) of HEUs and 62.1% of breastfeeding HEUs were on extended PNP. Log binomial regression analysis showed HEUs on extended PNP and CLHIV had increased likelihood of breastfeeding (prevalence ratio (PR) 1.8 (95% confidence interval (CI) 1.2 - 2.6) and PR 2.6 (95% CI 1.6 - 4.4), compared with eligible HEUs who were not on extended PNP. Conclusion. Good antiretroviral coverage supported safe breastfeeding practices during the COVID-19 peak lockdown in this rural setting in SA, with promising ongoing adoption of extended PNP during breastfeeding.