{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T06:48:15Z","timestamp":1771051695038,"version":"3.50.1"},"reference-count":52,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T00:00:00Z","timestamp":1659398400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["CoAg GH000479"],"award-info":[{"award-number":["CoAg GH000479"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>World Health Organization recommends promoting breastfeeding without restricting its duration among HIV-positive women on lifelong antiretroviral treatment (ART). There is little data on breastfeeding duration and mother to child transmission (MTCT) beyond 24 months. We compared the duration of breastfeeding in HIV-exposed and HIV-unexposed children and we identified factors associated with postpartum-MTCT in a semi-rural population of Mozambique.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This cross-sectional assessment was conducted from October-2017 to April-2018. Mothers who had given birth within the previous 48-months in the Manhi\u00e7a district were randomly selected to be surveyed and to receive an HIV-test along with their children. Postpartum MTCT was defined as children with an initial HIV positive result beyond 6 weeks of life who initiated breastfeeding if they had a first negative PCR result during the first 6 weeks of life or whose mother had an estimated date of infection after the child\u2019s birth. Cumulative incidence accounting for right-censoring was used to compare breastfeeding duration in HIV-exposed and unexposed children. Fine-Gray regression was used to assess factors associated with postpartum-MTCT.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among the 5000 mother-child pairs selected, 69.7% (3486\/5000) were located and enrolled. Among those, 27.7% (967\/3486) children were HIV-exposed, 62.2% (2169\/3486) were HIV-unexposed and for 10.0% (350\/3486) HIV-exposure was unknown. Median duration of breastfeeding was 13.0 (95%CI:12.0\u201314.0) and 20.0 (95%CI:19.0\u201320.0) months among HIV-exposed and HIV-unexposed children, respectively (p&lt;0.001). Of the 967 HIV-exposed children, 5.3% (51\/967) were HIV-positive at the time of the survey. We estimated that 27.5% (14\/51) of the MTCT occurred during pregnancy and delivery, 49.0% (2551) postpartum-MTCT and the period of MTCT remained unknown for 23.5% (12\/51) of children. In multivariable analysis, mothers\u2019 ART initiation after the date of childbirth was associated (aSHR:9.39 [95%CI:1.75\u201350.31], p = 0.001), however breastfeeding duration was not associated with postpartum-MTCT (aSHR:0.99 [95%CI:0.96\u20131.03], p = 0.707).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The risk for postpartum MTCT was nearly tenfold higher in women newly diagnosed and\/or initiating ART postpartum. This highlights the importance of sustained HIV screening and prompt ART initiation in postpartum women in Sub-Saharan African countries. Under conditions where HIV-exposed infants born to mothers on ART receive adequate PMTCT, extending breastfeeding duration may be recommended.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0269835","type":"journal-article","created":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T19:11:29Z","timestamp":1659467489000},"page":"e0269835","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Prompt HIV diagnosis and antiretroviral treatment in postpartum women is crucial for prevention of mother to child transmission during breastfeeding: Survey results in a high HIV prevalence community in southern Mozambique after the implementation of Option B+"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3684-6713","authenticated-orcid":true,"given":"Sheila","family":"Fern\u00e1ndez-Luis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Fuente-Soro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tacilta","family":"Nhampossa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Lopez-Varela","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0005-3968","authenticated-orcid":true,"given":"Orvalho","family":"Augusto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariel","family":"Nhacolo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olalla","family":"Vazquez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Saura-L\u00e1zaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helga","family":"Guambe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kwalila","family":"Tibana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernadette","family":"Ngeno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adelino Jos\u00e9 Chingore","family":"Juga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica Greenberg","family":"Cowan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marilena","family":"Urso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denise","family":"Naniche","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,8,2]]},"reference":[{"key":"pone.0269835.ref001","unstructured":"UNAIDS (Joint United Nations Programme on HIV\/AIDS), \u201cUNAIDS DATA 2019,\u201d 2019, [Online]. 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Bispo","year":"2017","journal-title":"Journal of the International AIDS Society"},{"key":"pone.0269835.ref005","unstructured":"UNAIDS, \u201cStart Free Stay Free AIDS Free 2019,\u201d 2019."},{"issue":"9202","key":"pone.0269835.ref006","first-page":"451","article-title":"WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality.","volume":"355","author":"Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis","year":"2000","journal-title":"Lancet (London, England)"},{"key":"pone.0269835.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5402\/2012\/763591","article-title":"Effect of Formula Feeding and Breastfeeding on Child Growth, Infant Mortality, and HIV Transmission in Children Born to HIV-Infected Pregnant Women Who Received Triple Antiretroviral Therapy in a Resource-Limited Setting: Data from an HIV Cohort Study in India","volume":"2012","author":"G. 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AIDS Res."},{"issue":"1","key":"pone.0269835.ref052","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1186\/s12889-019-6949-0","article-title":"A realist review of infant feeding counselling to increase exclusive breastfeeding by HIV-positive women in sub Saharan-Africa: what works for whom and in what contexts","volume":"19","author":"S. Nyoni","year":"2019","journal-title":"BMC Public Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269835","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,2]],"date-time":"2022-08-02T19:12:13Z","timestamp":1659467533000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0269835"}},"subtitle":[],"editor":[{"given":"Rena C.","family":"Patel","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,8,2]]},"references-count":52,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0269835","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,2]]}}}