HIV-INFECTION AND BREAST-FEEDING - POLICY IMPLICATIONS THROUGH A DECISION-ANALYSIS MODEL
HIV-INFECTION AND BREAST-FEEDING - POLICY IMPLICATIONS THROUGH A DECISION-ANALYSIS MODEL
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DOI：
10.1097/00002030-199212000-00014
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发表时间：
1992-12-01
期刊：
影响因子：
3.8
通讯作者：
HEYMANN, DL
中科院分区：
文献类型：
--
作者：
HU, DJ;HEYWARD, WL;HEYMANN, DL
目的：（1）开发一个综合决策分析模型，以比较不同人群中与母乳喂养和非母乳喂养艾滋病毒传播相关的死亡率;（2）进行敏感性分析，以说明指导研究和政策的关键界限。使用决策树，估计所有儿童的死亡率，母亲在怀孕期间感染的儿童，以及分娩时未受感染的母亲所生的孩子。考虑到儿童死亡率、非母乳喂养儿童与母乳喂养儿童的相对死亡风险、母乳喂养的艾滋病毒传播率、艾滋病毒流行率和艾滋病毒发病率等各种假设，我们创建了各种情景，并进行了敏感性分析，以划定关键边界。我们的模型表明，只有在R约小于或等于1.5且艾滋病毒发病率/流行率高（流行率> 10%，发病率> 5%）的情况下，与非母乳喂养相比，普及母乳喂养才会导致相等或更高的死亡率。在许多发展中国家的人口中，如果不实行母乳喂养，死亡的相对风险很高，如果R > 3，母乳喂养的儿童，即使是由感染艾滋病毒的母亲喂养的儿童，总的死亡率几乎总是较低。在已知产妇艾滋病毒状况的情况下，是否进行母乳喂养的决定在很大程度上取决于如果不进行母乳喂养，婴儿额外死亡风险的大小。该模型说明了区分人口和个人recommends.Conclusions的重要性：根据现有的数据，该模型支持目前世界卫生组织和疾病控制中心的建议，艾滋病毒感染和母乳喂养。鉴于母乳喂养的重要性和艾滋病毒感染的全球影响，需要进行更多的研究，特别是要澄清母乳喂养的艾滋病毒传播率范围，并扩大对世界不同地区相对风险的具体评估。
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 less-than-or-equal-to 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.