Research Project: Infant feeding practices in HIV-infected mothers in Canada: Understanding the psychosocial, medical and biological context of breast feeding and breast-milk transmission

Postdoc Year(s): 2014-2016

Dr. Sarah Khan is a Paediatric Infectious Diseases Fellow at The Hospital for Sick Children in Toronto. Dr. Khan focuses on pediatric HIV care, and her CTN-funded research aims to understand the biologic, psychosocial, and medical factors related to infant feeding practices for women living with HIV in Canada.

While guidelines in developed countries recommend exclusive formula feeding for women living with HIV, barriers to implementing this exist even in resource-rich Canada.

“As a pediatrician, I recognize the benefits of breastfeeding, and as a woman, I see the importance of women with HIV being informed and counselled on to the risks and benefits. I don’t think this issue is black and white in terms of legal or child protection implications,” says Dr. Khan.

Although there is a body of literature from low and middle-income countries regarding HIV transmission risk from breastfeeding, how much of this can be borrowed and applied to the Canadian context is unclear.  

“I think my interest in paediatric HIV research stems from wanting to care not just for kids, but their families and communities,” she says. “Because paediatric care is a field that transcends generations, ethnicities, and communities, it is vital for a multicultural country like Canada to ensure we are providing the highest standard of evidence based care.”

The main goal of paediatric HIV care is to prevent mother-to-child transmission (MTCT). “Maybe more can be done to ensure our patients are getting the best and safest care, perhaps we can help to reduce stigma, or improve knowledge for women and come to a consensus on infant feeding in HIV in Canada,” says Dr. Khan.

So far, Dr. Khan’s research has been fruitful. She has developed a questionnaire to assess knowledge, practices and attitudes towards infant feeding in the HIV context for care providers. She has also received funding for a project focusing on attitudes of women with HIV towards infant feeding through the St. Michael’s Hospital Innovation Funds. Furthermore, Dr. Khan is working on a literature review to outline the current understanding of antiretroviral levels in breast milk, and potential adverse events in infants.

“I am hopeful this research will be seen as a priority in the HIV community,” she says, “and lays the groundwork for a comprehensive assessment of research priorities in infant feeding in the Canadian HIV context.” Dr. Khan’s fellowship award has been extended for another year to allow her to complete the analysis and publish her findings.

Dr. Khan is working with a multidisciplinary team of pediatric HIV specialists including Drs. Ari Bitnun and Stanley Read, Adult/Women’s HIV Specialist Dr. Mona Loutfy, and Obstetrician Dr. Mark Yudin. She received her MD at the University of Ottawa in 2009, following up with a paediatric residency at McMaster University, infectious diseases subspecialty training at the University of Toronto, and is currently a pursuing a Masters in Health Research Methodology at McMaster University.

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