1. Severe household food insecurity is highly prevalent and associated with suboptimal breastfeeding practices among HIV-infected women in rural Uganda S.L. Young*, B.K. Natamba, F.A. Luwedde, A.H.J. Plenty, J. Mwesigwa, P. Natureeba, B. Osterbauer, J. Achan, T.D. Clark, V. Ades, M. Robine, B.K. Nzarubara, T.D. Ruel, M. Kamya, E.D. Charlebois, D.V. Havlir, D.L. Cohan *sera.young@cornell.edu The primary sponsor of the PROMOTE-PIs trial is the National Institute for Child Health and Human Development. The nutritional sub-study was supported by PEPFAR, the Office of the Global AIDS Coordinator, and the Office of AIDS Research. Abbott Laboratories provides Lopinavir/ritonavir for the parent trial.

2. Study Overview Background. Optimal infant feeding is critical to child health. Food insecurity may be an important barrier. Objective. To determine if food insecurity was associated with sub-optimal IF practices. Population (PROMOTE PIs). HIV-infected lactating women on combination ART. Design. 1. Prospective cohort (n=185). Monthly maternal recall of infant feeding, one-time household food insecurity assessment (HFIAS). 2. Qualitative study (n=56): in-depth interviews about food insecurity and infant feeding. Primary outcomes. Prevalence of food insecurity, exclusive breastfeeding at 6 months. Analysis. Logistic regression & thematic coding of qualitative data.

3. Results (1). The prevalence of household food insecurity was 98.9% Results (2). Exclusive breastfeeding was lower than recommended, but higher than national figures Results (4). In-depth interviews confirmed role of food insecurity in difficulties with optimal breastfeeding. “... if you do not eat properly, then there would be no breast milk. So if you stay hungry for a long time, milk flow will be affected.” Conclusion. The mitigation of food insecurity may increase the duration of EBF and BF among HIV-infected women in rural Uganda. Results (3). Logistic regression of EBF at 6 months* nAdjusted p- value Food secure, and mildly or moderately insecure Severely food secure 185ref 0.40 (0.16-0.98) 0.047 BMI (within 1m of delivery)1850.87 (0.77-0.98)0.025 <2 y since HIV diagnosis >2 y 1852.18 (1.10-4.33)0.026 *After adjusting for maternal education and assets. Severely food insecure women were 60% less likely to EBF