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Individualizing the WHO HIV and infant feeding guidelines: optimal breastfeeding duration to maximize infant HIV-free survival.

ABSTRACT: To determine how infant feeding recommendations can maximize HIV-free survival (HFS) among HIV-exposed, uninfected African infants, balancing risks of breast milk-associated HIV infection with setting-specific risks of illness and death associated with replacement feeding.Validated mathematical model of HIV-exposed, uninfected infants, with published data from Africa.We projected 24-month HFS using combinations of: maternal CD4, antiretroviral drug availability, and relative risk of mortality among replacement-fed compared to breastfed infants ('RR-RF', range 1.0-6.0). For each combination, we identified the 'optimal' breastfeeding duration (0-24 months) maximizing HFS. We compared HFS under an 'individualized' approach, based on the above parameters, to the WHO 'public health approach' (12 months breastfeeding for all HIV-infected women).Projected HFS was 65-93%. When the value of RR-RF is 1.0, replacement feeding from birth maximized HFS. At a commonly reported RR-RF value (2.0), optimal breastfeeding duration was 3-12 months, depending on maternal CD4 and antiretroviral drug availability. As the value of RR-RF increased, optimal breastfeeding duration increased. Compared to the public health approach, an individualized approach improved absolute HFS by less than 1% if RR-RF value was 2.0-4.0, by 3% if RR-RF value was 1.0 or 6.0, and by greater amounts if access to antiretroviral drugs was limited.Tailoring breastfeeding duration to maternal CD4, antiretroviral drug availability, and local replacement feeding safety can optimize HFS among HIV-exposed infants. An individualized approach leads to moderate gains in HFS, but only when mortality risks from replacement feeding are very low or very high, or antiretroviral drug availability is limited. The WHO public health approach is beneficial in most resource-limited settings.

SUBMITTER: Ciaranello AL

PROVIDER: S-EPMC4098721 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Project description:Public health initiatives (e.g., the Baby Friendly Hospital Initiative) have led to an increase in breastfeeding rates worldwide. However, as (exclusive) breastfeeding duration is still below WHO recommendations, it is crucial to understand the factors that influence decisions on breastfeeding practice. Modifiable psychological factors such as intention to breastfeed have therefore become targets of recent interventions. As the intention to breastfeed is among the strongest predictors of breastfeeding duration, reliable tools for measuring the intention to breastfeed are needed. The Iowa Infant Feeding Attitude Scale (IIFAS) measures attitudes towards infant feeding and is used in various languages and across different cultural contexts. However, there has been no German version of the IIFAS (IIFAS-G) so far. The aim of this study was to investigate reliability, validity, and associations of the IIFAS-G with feeding method and breastfeeding duration. Between August and November 2022, a total of 353 mothers (Mage = 35 years, SDage = 4.2 years) of singleton infants (47.3% female (1 undetermined), Mage = 10.8 months, SDage = 4.7 months, age range: 3-547 days; 90.4% living in Switzerland) participated in an online survey. The IIFAS-G was administered as a part of a larger study on early child development and infant feeding method. The translated IIFAS-G showed unsatisfactory model fit for the two factor 17-item solution. Four items showed low factor loadings. After item reduction, a 13-item two factor solution showed satisfactory model fit (CFI = 0.92, TLI = 0.90, RMSEA = 0.07) and high internal consistency (Cronbach's α = 0.85). The IIFAS-G score was higher for mothers who exclusively breastfed their infants compared to mothers who additionally or exclusively fed infant formula. Moreover, mothers with higher IIFAS-G scores were less likely to stop breastfeeding their child over the course of 1.5years (HR = 0.87). A shorter two-factor IIFAS-G is proposed to investigate attitudes towards breastfeeding and formula feeding in German-speaking mothers.

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Individualizing the WHO HIV and infant feeding guidelines: optimal breastfeeding duration to maximize infant HIV-free survival.

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