不同 HIV 感染状况的产妇母乳喂养持续时间差异：撒哈拉以南非洲国家代表性调查的汇总分析。

Differences in Breastfeeding Duration by Maternal HIV Status: A Pooled Analysis of Nationally Representative Surveys in Sub-Saharan Africa.

机构信息

Center for Modeling, Planning and Policy Analysis, Avenir Health, Glastonbury, CT.

Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.

出版信息

J Acquir Immune Defic Syndr. 2024 Jan 1;95(1S):e81-e88. doi: 10.1097/QAI.0000000000003317. Epub 2024 Jan 4.

BACKGROUND

Breastfeeding improves child survival but is a source of mother-to-child HIV transmission among women with unsuppressed HIV infection. Estimated HIV incidence in children is sensitive to breastfeeding duration among mothers living with HIV (MLHIV). Breastfeeding duration may vary according to maternal HIV status.

SETTING

Sub-Saharan Africa.

METHODS

We analyzed pooled data from nationally representative household surveys conducted during 2003-2019 that included HIV testing and elicited breastfeeding practices. We fitted survival models of breastfeeding duration by country, year, and maternal HIV status for 4 sub-Saharan African regions (Eastern, Central, Southern, and Western).

RESULTS

Data were obtained from 65 surveys in 31 countries. In 2010, breastfeeding in the first month of life ("initial breastfeeding") among MLHIV ranged from 69.1% (95% credible interval: 68-79.9) in Southern Africa to 93.4% (92.7-98.0) in Western Africa. Median breastfeeding duration among MLHIV was the shortest in Southern Africa at 15.6 (14.2-16.3) months and the longest in Eastern Africa at 22.0 (21.7-22.5) months. By comparison, HIV-negative mothers were more likely to breastfeed initially (91.0%-98.7% across regions) and for longer duration (median 18.3-24.6 months across regions). Initial breastfeeding and median breastfeeding duration decreased during 2005-2015 in most regions and did not increase in any region regardless of maternal HIV status.

CONCLUSIONS

MLHIV in sub-Saharan Africa are less likely to breastfeed initially and stop breastfeeding sooner than HIV-negative mothers. Since 2020, UNAIDS-supported HIV estimates have accounted for this shorter breastfeeding exposure among HIV-exposed children. MLHIV need support to enable optimal breastfeeding practices and to adhere to antiretroviral therapy for HIV treatment and prevention of postnatal mother-to-child transmission.

背景

母乳喂养可提高儿童存活率，但在未接受抑制的 HIV 感染的女性中，是母婴 HIV 传播的一个来源。在感染 HIV 的母亲（MLHIV）中，儿童估计 HIV 发病率对母乳喂养持续时间敏感。母乳喂养持续时间可能因母亲的 HIV 状况而异。

地点

撒哈拉以南非洲。

方法

我们分析了 2003 年至 2019 年期间在全国范围内进行的具有代表性的家庭调查的汇总数据，这些调查包括 HIV 检测和母乳喂养实践。我们为撒哈拉以南非洲的 4 个地区（东部、中部、南部和西部）拟合了按国家、年份和母亲 HIV 状况划分的母乳喂养持续时间的生存模型。

结果

数据来自 31 个国家的 65 项调查。在 2010 年，MLHIV 中婴儿出生后第一个月的母乳喂养（“初始母乳喂养”），在南部非洲的比例为 69.1%（95%可信区间：68-79.9），在西部非洲的比例为 93.4%（92.7-98.0）。MLHIV 中母乳喂养的中位数持续时间最短，在南部非洲为 15.6 个月（14.2-16.3 个月），在东部非洲最长为 22.0 个月（21.7-22.5 个月）。相比之下，HIV 阴性的母亲更有可能进行初始母乳喂养（91.0%-98.7%，各个地区），并且母乳喂养持续时间更长（中位数为 18.3-24.6 个月，各个地区）。在大多数地区，2005 年至 2015 年期间，初始母乳喂养和中位数母乳喂养持续时间下降，而无论母亲的 HIV 状况如何，在任何地区都没有增加。

结论

撒哈拉以南非洲的 MLHIV 最初母乳喂养的可能性较低，并且比 HIV 阴性的母亲更早停止母乳喂养。自 2020 年以来，UNAIDS 支持的 HIV 估计数已经考虑到了 HIV 暴露儿童母乳喂养时间较短的情况。MLHIV 需要支持，以使其能够采用最佳的母乳喂养方式，并坚持接受抗逆转录病毒疗法，以治疗 HIV 并预防产后母婴传播。