Decision analysis to guide choice of interventions to reduce mother-to-child transmission of HIV
Decision analysis to guide choice of interventions to reduce mother-to-child transmission of HIV
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DOI：
10.1097/00002030-200309260-00010
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发表时间：
2003-09-26
期刊：
影响因子：
3.8
通讯作者：
Simonds, RJ
中科院分区：
文献类型：
--
作者：
Bertolli, J;Hu, DJ;Simonds, RJ
简介：抗逆转录病毒预防，避免母乳喂养，早期断奶的候选人，以防止母婴传播（MTCT）的HIV Worldwide.Methods：我们开发了一个模型，以帮助指导人口水平的决定有关母婴传播干预策略。我们估计了在发展中国家的典型情况下，通过（1）产前短程齐多夫定，（2）产时和新生儿短程奈韦拉平，（3）避免母乳喂养和（4）早期断奶（6个月）预防的幼儿死亡人数;四种组合;以及一种可能的未来策略（产后抗逆转录病毒预防）。我们评估了一系列R干预措施的有效性，与母乳喂养的儿童相比，暴露于母乳喂养干预措施的儿童的相对死亡风险（独立于HIV感染）。我们还估计减少母乳喂养传播所需的产后抗逆转录病毒干预，以防止更多的幼儿死亡比目前可用的interventions.Results：当R小于或等于1.5，战略相结合的抗逆转录病毒预防与母乳喂养干预措施，防止最早的儿童死亡。然而，当R > 1.5和R > 1.9时，分别包括早期断奶和避免母乳喂养的策略可能会导致比没有干预的情况更多的死亡。与避免母乳喂养相比，产后抗逆转录病毒干预的相对有效性随R而变化，因此，如果通过母乳喂养将艾滋病毒传播减少25%，则在任何R下，干预都比早期断奶作为单一干预更有效。这个电子表格模型是一个简单的，也可因地制宜[使决策者能够探讨预防母婴传播艾滋病毒的干预战略的关键问题。(C)2003年利平科特威廉姆斯威尔金斯。
Introduction: Antiretroviral prophylaxis, avoidance of breastfeeding, and early weaning are candidates to prevent mother-to-child transmission (MTCT) of HIV worldwide.Methods: We developed a model to help guide population-level decisions about MTCT intervention strategies. We estimated the numbers of early childhood deaths prevented by (1) prenatal short-course zidovudine, (2) intrapartum and neonatal shortcourse nevirapine, (3) avoidance of breastfeeding, and (4) early weaning (age 6 months); four combinations of these; and one possible future strategy (postnatal antiretroviral prophylaxis) in a scenario typical of a developing country. We evaluated the effectiveness of the interventions for a range of R, the relative risk of mortality for children exposed to breastfeeding interventions compared with breastfed children (independent of HIV infection). We also estimated the reduction in breastfeeding transmission needed for a postnatal antiretroviral intervention to prevent more early childhood deaths than do currently available interventions.Results: Where R less than or equal to 1.5, strategies combining antiretroviral prophylaxis with breastfeeding interventions prevent the most early childhood deaths. However, strategies that include early weaning and avoidance of breastfeeding, respectively, can result in more deaths than with no intervention when R > 1.5 and R > 1.9, respectively. The relative effectiveness of a postnatal antiretroviral intervention compared with avoidance of breastfeeding varies with R, such that an intervention would be more effective than early weaning as a single intervention, at any R, if it reduced HIV transmission through breastfeeding by 25%.Conclusion: This spreadsheet model is a simple, locally adaptable too[ to allow decision-makers to explore key questions about intervention strategies to prevent MTCT of HIV. (C) 2003 Lippincott Williams Wilkins.