Interventions to support breastfeeding among mothers living with HIV: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Breastfeeding improves infant survival, especially in low-resource settings. Although the risk of postnatal transmission is below 1% among virologically suppressed mothers living with HIV, exclusive breastfeeding (EBF) rates and retention in HIV care remain suboptimal. This review evaluated the effect of non-pharmacological interventions aimed at supporting breastfeeding among people living with HIV (PLWH). METHODS: We searched PubMed, Embase, and Cochrane Library up to Jan 1, 2025, for randomized controlled trials (RCTs) assessing facility- and community-based interventions. Outcomes included any breastfeeding, EBF, maternal-infant retention, and maternal viral suppression. Risk of bias was assessed using the Cochrane RoB2 tool. Data were pooled using a random-effects meta-analysis, and evidence certainty was rated using GRADE. The study adhered to PRISMA statements and was registered with PROSPERO, https://www.crd.york.ac.uk/PROSPERO/view/CRD42025636327. FINDINGS: Eight RCTs (n = 3715) from South Africa, Uganda, Kenya, and India were included. Healthcare support was associated with a borderline increase in maternal viral suppression (RR 1.21, 95% CI 1.00–1.47), corresponding to 140 more per 1,000 mothers. Pooled interventions improved EBF uptake (RR 1.38, 95% CI 1.06–1.80), corresponding to 92 more per 1,000 mothers. Certainty of evidence was low to very low. CONCLUSIONS: Facility- and community-based interventions may increase EBF among PLWH. The main limitation of the included RCT was the absence of blinding. No publication bias was detected. More context-specific trials are needed to assess their impact on HIV-related outcomes.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Housing
  • Food security
  • Education
  • Social support
  • Health services
  • Stigma/discrimination
  • Other
• Population(s)
  • Women
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
  • Prevention
• Engagement and Care Cascade
  • Treatment
• Prevention
  • Biomedical interventions
• Health Systems
  • Delivery arrangements