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HIV infection and breast-feeding: policy implications through a decision analysis model
D J Hu1, W L Heyward, R H Byers
1Division of HIV/AIDS, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Georgia.
AIDS (London, England)
|December 11, 1992
Summary
Breast-feeding by mothers with human immunodeficiency virus (HIV) is generally safer than not breast-feeding, especially in developing countries. The decision depends on the relative risk of mortality if not breast-feeding.
Area of Science:
- Public Health
- Epidemiology
- Decision Science
Background:
- Human immunodeficiency virus (HIV) transmission from mother to child remains a global health concern.
- Breast-feeding is a critical factor in infant nutrition but poses a risk for HIV transmission.
- Existing recommendations balance the benefits of breast-feeding against the risks of HIV transmission.
Purpose of the Study:
- To develop a decision analysis model comparing mortality risks of breast-feeding versus not breast-feeding in diverse populations.
- To conduct sensitivity analyses to identify critical thresholds for research and policy guidance.
Main Methods:
- A decision tree model was employed to estimate mortality rates under various scenarios.
- Key variables included child mortality rates, relative mortality risks of non-breast-feeding (R), HIV transmission rates, prevalence, and incidence.
- Sensitivity analyses were performed to determine critical boundaries for decision-making.
Main Results:
- Universal breast-feeding is associated with equal or higher mortality only when the relative risk of mortality from not breast-feeding (R) is low (≤1.5) and HIV incidence/prevalence is high (>10% prevalence, >5% incidence).
- In many developing countries, where the mortality risk from not breast-feeding is high (R > 3), breast-feeding by HIV-infected mothers results in lower overall child mortality.
- The decision to breast-feed is heavily influenced by the magnitude of mortality risk associated with not breast-feeding, particularly when maternal HIV status is known.
Conclusions:
- The model supports current World Health Organization and Centers for Disease Control recommendations regarding HIV and breast-feeding.
- Further research is essential to refine HIV transmission rates from breast-feeding and assess relative risks globally.
- Distinguishing between population-level and individual-level recommendations is crucial for effective public health strategies.
Keywords:
AfricaAfrica South Of The SaharaAmericasAsiaBehaviorBreast FeedingCdcChild MortalityComparative StudiesDecision MakingDemographic FactorsDeveloped CountriesDeveloping CountriesDiseasesEuropeGovernment AgenciesHealthHiv Infections--transmissionInfant MortalityInfant NutritionInternational AgenciesMethodological StudiesMiddle AfricaModels, TheoreticalMortalityNorth AmericaNorthern AmericaNutritionOrganization And AdministrationOrganizationsPlanningPolicy DevelopmentPopulationPopulation CharacteristicsPopulation DynamicsPregnant WomenRecommendationsResearch MethodologyStudiesUnUsphsViral DiseasesWestern EuropeWho