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HIV infection and breast-feeding: policy implications through a decision analysis model.
AIDS 1992; 6(12):1505-13AIDS

Abstract

OBJECTIVES

(1) To develop a comprehensive decision analysis model to compare mortality associated with HIV transmission from breast-feeding with the mortality from not breast-feeding in different populations and (2) to perform sensitivity analyses to illustrate critical boundaries for guiding research and policy.

METHODS

Using a decision tree, mortality rates were estimated for all children, children born to mothers infected during pregnancy, and children born to mothers who were uninfected at delivery. Given various assumptions about child mortality rates, relative risks of mortality among children who are not breast-fed compared with those who are (R), rates of HIV transmission from breast-feeding, HIV prevalence, and HIV incidence, scenarios were created and sensitivity analysis used to delineate critical boundaries.

RESULTS

Our model shows that only in situations where R is approximately < or = 1.5 and HIV incidence/prevalence is high (prevalence > 10%, incidence > 5%) would universal breast-feeding result in equal or higher mortality compared with non-breast-feeding. Among populations in many developing countries, where there is a high relative risk of mortality if breast-feeding is not practiced, if R > 3, overall mortality is almost always lower among children who are breast-fed, even by HIV-infected mothers. In situations where maternal HIV status is known, the decision whether to breast-feed is largely dependent on the magnitude of additional mortality risk if the child is not breast-fed. The model illustrates the importance of distinguishing between population and individual recommendations.

CONCLUSIONS

Based on available data, the model supports current World Health Organization and Centers for Disease Control recommendations on HIV infection and breast-feeding. Given the importance of breast-feeding and the global impact of HIV infection, more research is needed, especially to clarify the range of HIV transmission rates from breast-feeding and to expand specific assessments of relative risks for different areas of the world.

Authors+Show Affiliations

Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

1492933

Citation

Hu, D J., et al. "HIV Infection and Breast-feeding: Policy Implications Through a Decision Analysis Model." AIDS (London, England), vol. 6, no. 12, 1992, pp. 1505-13.
Hu DJ, Heyward WL, Byers RH, et al. HIV infection and breast-feeding: policy implications through a decision analysis model. AIDS. 1992;6(12):1505-13.
Hu, D. J., Heyward, W. L., Byers, R. H., Nkowane, B. M., Oxtoby, M. J., Holck, S. E., & Heymann, D. L. (1992). HIV infection and breast-feeding: policy implications through a decision analysis model. AIDS (London, England), 6(12), pp. 1505-13.
Hu DJ, et al. HIV Infection and Breast-feeding: Policy Implications Through a Decision Analysis Model. AIDS. 1992;6(12):1505-13. PubMed PMID: 1492933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HIV infection and breast-feeding: policy implications through a decision analysis model. AU - Hu,D J, AU - Heyward,W L, AU - Byers,R H,Jr AU - Nkowane,B M, AU - Oxtoby,M J, AU - Holck,S E, AU - Heymann,D L, PY - 1992/12/11/pubmed PY - 2001/3/28/medline PY - 1992/12/11/entrez KW - Africa KW - Africa South Of The Sahara KW - Americas KW - Asia KW - Behavior KW - Breast Feeding KW - Cdc KW - Child Mortality KW - Comparative Studies KW - Decision Making KW - Demographic Factors KW - Developed Countries KW - Developing Countries KW - Diseases KW - Europe KW - Government Agencies KW - Health KW - Hiv Infections--transmission KW - Infant Mortality KW - Infant Nutrition KW - International Agencies KW - Methodological Studies KW - Middle Africa KW - Models, Theoretical KW - Mortality KW - North America KW - Northern America KW - Nutrition KW - Organization And Administration KW - Organizations KW - Planning KW - Policy Development KW - Population KW - Population Characteristics KW - Population Dynamics KW - Pregnant Women KW - Recommendations KW - Research Methodology KW - Studies KW - Un KW - Usphs KW - Viral Diseases KW - Western Europe KW - Who SP - 1505 EP - 13 JF - AIDS (London, England) JO - AIDS VL - 6 IS - 12 N2 - OBJECTIVES: (1) To develop a comprehensive decision analysis model to compare mortality associated with HIV transmission from breast-feeding with the mortality from not breast-feeding in different populations and (2) to perform sensitivity analyses to illustrate critical boundaries for guiding research and policy. METHODS: Using a decision tree, mortality rates were estimated for all children, children born to mothers infected during pregnancy, and children born to mothers who were uninfected at delivery. Given various assumptions about child mortality rates, relative risks of mortality among children who are not breast-fed compared with those who are (R), rates of HIV transmission from breast-feeding, HIV prevalence, and HIV incidence, scenarios were created and sensitivity analysis used to delineate critical boundaries. RESULTS: Our model shows that only in situations where R is approximately < or = 1.5 and HIV incidence/prevalence is high (prevalence > 10%, incidence > 5%) would universal breast-feeding result in equal or higher mortality compared with non-breast-feeding. Among populations in many developing countries, where there is a high relative risk of mortality if breast-feeding is not practiced, if R > 3, overall mortality is almost always lower among children who are breast-fed, even by HIV-infected mothers. In situations where maternal HIV status is known, the decision whether to breast-feed is largely dependent on the magnitude of additional mortality risk if the child is not breast-fed. The model illustrates the importance of distinguishing between population and individual recommendations. CONCLUSIONS: Based on available data, the model supports current World Health Organization and Centers for Disease Control recommendations on HIV infection and breast-feeding. Given the importance of breast-feeding and the global impact of HIV infection, more research is needed, especially to clarify the range of HIV transmission rates from breast-feeding and to expand specific assessments of relative risks for different areas of the world. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/1492933/HIV_infection_and_breast_feeding:_policy_implications_through_a_decision_analysis_model_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=1492933.ui DB - PRIME DP - Unbound Medicine ER -