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Modeling Maternal–Infant HIV Transmission in the Presence of Breastfeeding with an Imperfect Test
Author(s) -
Gupte N.,
Brookmeyer R.,
Bollinger R.,
Gray G.
Publication year - 2007
Publication title -
biometrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.298
H-Index - 130
eISSN - 1541-0420
pISSN - 0006-341X
DOI - 10.1111/j.1541-0420.2007.00777.x
Subject(s) - breastfeeding , imperfect , test (biology) , transmission (telecommunications) , human immunodeficiency virus (hiv) , medicine , obstetrics , pediatrics , biology , computer science , virology , telecommunications , paleontology , philosophy , linguistics
Summary An important public health question is to determine the probabilities of perinatal HIV transmission and when it occurs, whether antepartum, intrapartum, or postpartum through breastfeeding. However, this is a difficult problem because the presence of HIV infection in an infant can only be ascertained through viral assays in the postpartum period. We propose a model that simultaneously estimates the risks of antepartum, intrapartum, and postpartum transmissions together with the sensitivity of the screening tests for HIV infection. The model allows estimating of infectivity through breast milk during postpartum periods. The methods are illustrated on a South African randomized clinical trial of extended AZT versus a short course of nevirapine in infants whose mothers had no access to antenatal antiretroviral therapy.