Predictors of Exclusive Breastfeeding Amongst Mothers Living With HIV in Sub-Saharan Africa: A Scoping Review

Exclusive breastfeeding (EBF) reduces infant mortality and HIV vertical transmission (VT). The 2016 World Health Organisation (WHO) guidelines recommend 6 months of EBF for mothers living with HIV (MLWH) on antiretroviral therapy, yet uptake in sub-Saharan Africa (SSA) remains low, and evidence on predictors is fragmented. This scoping review synthesised quantitative evidence on predictors of EBF among MLWH in SSA since the 2016 WHO guidelines, identifying geographic gaps and methodological trends to guide research and policy.

Following Joanna Briggs Institute methodology and PRISMA-ScR reporting, five databases, PubMed, EMBASE, Web of Science, Scopus, and Global Health, were searched for studies conducted from 2016 onwards that quantitatively assessed predictors of EBF among MLWH in SSA. Included studies were descriptively synthesised and mapped by geography, frequency, association, and analysis type. Quality appraisal used the Mixed Methods Appraisal Tool 2018.

19 studies met inclusion criteria. Positive predictors included healthcare engagement, knowledge, favourable attitudes, and HIV-status disclosure. Negative/mixed predictors included employment, education, and pregnancy complications. Studies were geographically skewed (42% from Ethiopia), largely cross-sectional (74%), and facility-based. Psychosocial, socioeconomic, and biological/clinical barriers remain underexplored.

Evidence on EBF predictors among MLWH in SSA remains limited, geographically uneven, and methodologically restricted. Future research should adopt longitudinal, intervention-focused, and contextually diverse designs to inform scalable, culturally responsive strategies for improving EBF and preventing HIV VT.