Table 1.
Selected model input parameters for the CEPAC-infant model
| I. Mother-to-child transmission risks in postnatal period (rate/100 person-years, applied to infants HIV-uninfected at birth)
| ||||
|---|---|---|---|---|
| Base-case value (range for sensitivity analyses) a | ||||
|
| ||||
| Maternal CD4 | Postnatal PMTCT regimen received | |||
| No ARVs | Extended infant NVP | Three-drug ART | Data sources | |
| ≤350/μL | 9.1 (EBF); 15.4 (MBF) (5.7–28.4) | n/a | 4.0 (0–6.4) | [2, 6, 10, 12, 25, 27, 31–33] |
| >350/μL | 2.9 (EBF); 4.8 (MBF) (1.8–8.8) | 2.7 (1.4–3.7) | 2.2 (0–6.4) | [2, 11, 12, 16, 25–30] |
| II. Monthly risk of infant mortality among breastfed, HIV-exposed, uninfected infants [8, 40]
| |
|---|---|
| Age (months) b | Base-case value (range for sensitivity analyses) |
| 0–2 | 0.0101 (0.0091–0.0115) |
| 3–5 | 0.0041 (0.0038–0.0045) |
| 6–11 | 0.0028 (0.0028–0.0030) |
| 12–17 | 0.0014 (0.0012–0.0014) |
| 18–23 | 0.0007 (0.0005–0.0009) |
| III. Maternal mortality
| ||
|---|---|---|
| Maternal HIV/ARV status | Monthly risk | Data source |
| CD4≤350/μL, no ARVs | 0.0078 | Projected from CEPAC-International adult model (see Supplemental Appendix) |
| CD4>350/μL, no ARVs | 0.0024 | |
| CD4≤350/μL, maternal ART | 0.0016 | |
| CD4>350/μL, maternal ART | 0.0009 | |
| IV. Relative risk of mortality among replacement-fed compared to breastfed infants (RR-RF) c
| ||
|---|---|---|
| Reported values | Setting | References |
| 1.0 | Kenya; Rwanda; South Africa; Côte d’lvoire | [5, 16–18] |
| 2.0 | Botswana | [6] |
| 1.8–3.3 | Malawi | [19] |
| 2.0–4.2 | Zambia | [20, 42] |
| 6.0 | Uganda | [21] |
PMTCT: prevention of mother-to-child HIV transmission; EBF: exclusive breastfeeding (in first six months of life, followed by complementary feeding thereafter); MBF: mixed breastfeeding (in first six months of life, followed by complementary feeding thereafter); m: months; ARVs: antiretroviral drugs; ART: three-drug antiretroviral therapy.
The ranges shown for sensitivity analyses are the highest and lowest published values for each regimen. For the “highest MTCT risk” scenario, we used the upper limit of each range; for the “lowest MTCT risk” scenario, we used the lower limit. These MTCT ranges may represent a proxy for adherence to maternal and infant ARVs in PMTCT trials.
Mortality rates are stratified by current age in each month of the simulation.
The RR-RF was calculated by dividing cumulative mortality risk (at the greatest duration reported in each study) among replacement-fed infants by cumulative mortality risk among breastfed infants.