Background. Exclusive breastfeeding (EBF) to 6 months is recommended for HIV-infected mothers choosing to breastfeed and cessation thereafter if replacement feeding is AFASS. Data for this study were collected from participants in the BAN Study provided a lipid-based nutrient supplement (LNS) to replace breastmilk between 6-12mo.

Objective. Examine dietary intakes after early breastfeeding cessation using LNS as a breastmilk substitute; Explore maternal attitudes and experiences performing EBF, weaning, and the use of LNS; Determine the prevalence of dietary inadequacy after exiting the BAN Study; Examine the effect of early weaning on child growth.

Methods. The dietary intakes of a random sample of BAN Study infants (N=400) were analyzed using generalized estimating equations. After exiting the BAN Study, a subsample of mothers (N=45) were interviewed to understand the acceptance and feasibility of implementing the HIV and infant feeding guidelines using LNS. Anthropometric measurements were obtained between 15-16 and 17-18mo from 41 BAN-exited (non-breastfed) and 41 matched (still-breastfed) children from the community; 2 diet recalls were collected from BAN-exited children at each time point.

Results. Between 6-12mo, dietary intakes followed a seasonal pattern with greatest intakes during the cool season and lowest intakes during the hungry season. The contribution of LNS to total intake was greatest during the hungry and cool seasons. Infants were dependent on LNS to provide fat, vitamin A, vitamin C, calcium, and iron. Mothers reported several weaning strategies, including gradual reduction of breastfeeding, expressing breastmilk into a cup, and separation of mother and child. LNS was accepted and incorporated into the traditional diet. After the BAN Study, non-breastfed children consumed adequate amounts of energy, protein, and carbohydrate but inadequate fat. The prevalence of inadequacy was: 46% for vitamin A; 20% for vitamin B6; 69% for folate; 13% for vitamin C; 19% for iron; 23% for zinc. Growth analyses found BAN-exited girls had significantly worse WAZ and LAZ scores over time (p=0.076) and significantly lower length and weight velocity (p<0.02).

Conclusions. Early breastfeeding cessation as an HIV prevention method proved feasible but has trade-offs in resource-poor settings such as inadequate dietary intakes and reduced infant growth.