Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
AIDS Res Ther. 2011 Oct 12;8(1):37. doi: 10.1186/1742-6405-8-37.
BACKGROUND: Partners In Health (PIH) works with the Ministry of Health to provide comprehensive health services in Haiti. Between 1994 and 2009, PIH recommended exclusive formula feeding in the prevention of mother-to-child transmission (PMTCT) of HIV program and provided support to implement this strategy. We conducted this study to assess HIV-free survival and prevalence of diarrhea and malnutrition among infants in our PMTCT program in rural Haiti where exclusive formula feeding was supported. METHODS: We reviewed medical charts of PMTCT mother-infant pairs at PIH between November 2004 and August 2006 through a retrospective longitudinal study and cross-sectional survey. We performed household surveys for each pair and at control households matched by infant's age and gender. RESULTS: 254 mother-infant pairs were included. 15.3% of infants were low birth weight; most births occurred at home (68.8%). 55.9% of households had no latrine; food insecurity was high (mean score of 18; scale 0-27, SD = 5.3). HIV-free survival at 18 months was 90.6%. Within the cohort, 9 children (3.5%) were HIV-infected and 17 (6.7%) died. Community controls were more likely to be breastfed (P = 0.003) and more likely to introduce food early (P = 0.003) than PMTCT-program households. There was no difference in moderate malnutrition (Z score ≤ 2 SD) between PMTCT and community groups after controlling for guardian's education, marital status, and food insecurity (OR = 1.05; 95% CI: 0.67, 1.64; P = 0.84). Diarrhea was 2.9 times more prevalent among community children than PMTCT infants (30.3% vs. 12.2%; P < 0.0001). CONCLUSIONS: In a PIH-supported program in rural Haiti that addressed socioeconomic barriers to ill-health, breast milk substitution was safe, acceptable and feasible for PMTCT for HIV-infected women choosing this option.
背景：Partners In Health（PIH）与卫生部合作，在海地提供全面的卫生服务。1994 年至 2009 年期间，PIH 在预防母婴传播（PMTCT）艾滋病毒项目中推荐了配方奶喂养，并为实施这一策略提供了支持。我们进行了这项研究，以评估在海地农村的 PMTCT 项目中，支持完全配方奶喂养的情况下，HIV 阴性婴儿的存活率和腹泻与营养不良的发生率。
方法：我们通过回顾性纵向研究和横断面调查，对 2004 年 11 月至 2006 年 8 月期间 PIH 的 PMTCT 母婴对的医疗记录进行了审查。我们对每对母婴及其在年龄和性别匹配的对照家庭进行了家庭调查。
结果：共有 254 对母婴对被纳入研究。15.3%的婴儿为低出生体重儿；大多数分娩发生在家中（68.8%）。55.9%的家庭没有厕所；粮食不安全状况严重（平均得分为 18 分；0-27 分，标准差为 5.3）。18 个月时的 HIV 阴性存活率为 90.6%。在该队列中，有 9 名儿童（3.5%）感染了 HIV，有 17 名儿童（6.7%）死亡。社区对照组更有可能进行母乳喂养（P = 0.003），更有可能及早添加食物（P = 0.003），而 PMTCT 项目家庭则不然。在控制了监护人的教育、婚姻状况和粮食不安全状况后，PMTCT 组和社区组之间的中度营养不良（Z 分数≤2 个标准差）没有差异（OR = 1.05；95%CI：0.67，1.64；P = 0.84）。与 PMTCT 婴儿相比，社区儿童腹泻的发生率高出 2.9 倍（30.3%对 12.2%；P < 0.0001）。
结论：在 PIH 支持的海地农村项目中，针对影响健康的社会经济障碍，对于选择这种选择的感染艾滋病毒的妇女的 PMTCT，替代母乳是安全、可接受和可行的。
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