Questions and PICO used as the basis for preparing systematic reviews of the available published evidence

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Guideline: Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV. Geneva: World Health Organization; 2016.

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Guideline: Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV.

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Annex 5Questions and PICO used as the basis for preparing systematic reviews of the available published evidence

1	Question	For how long should a mother living with HIV breastfeed if she is receiving ART and there is no evidence of clinical, immune or viral failure? What is the HIV-free survival of HIV-exposed infants according to feeding practices when mothers are taking ARV drugs?	Importance
	Population	Infants of mothers living with HIV	Critical
	Intervention	Breastfeeding and maternal ARV drugs
	Comparison	Not breastfeeding or early cessation of breastfeeding No maternal ARV drugs
	Outcome	HIV transmission and HIV-free survival between birth and 24 months

2	Question	Can facility-and community-based interventions improve the quality of breastfeeding practices among mothers living with HIV?	Importance
	Population	Mothers living with HIV receiving ARV drugs	Important
	Intervention	Support and counselling delivered by facility-based or community-based health workers or peers (people living with HIV in the same community)
	Comparison	Standard care without support
	Outcome	Exclusive breastfeeding (three months and six months) Initiation of breastfeeding Early initiation of breastfeeding (within one hour of birth) Safe replacement feeding

3	Question	If a mother living with HIV does not exclusively breastfeed, is mixed feeding with ART better than no breastfeeding at all? Are ARV drugs effective in preventing the postnatal transmission of HIV through breast milk according to feeding modality?	Importance
	Population	Infants of mothers living with HIV receiving ARV drugs	Critical
	Intervention	Exclusive breastfeeding
	Comparison	Mixed feeding
	Outcome	HIV transmission and HIV-free survival

4	Question	If a mother living with HIV plans to return to work or school, is a shorter duration of planned breastfeeding with ART better than no breastfeeding at all? What is the HIV-free survival of infants breastfed for durations less than 12 months compared to breastfeeding for 12 months?	Importance
	Population	Infants of mothers living with HIV receiving ARV drugs	Critical
	Intervention	Breastfeeding for 12 months
	Comparison	Earlier cessation of breastfeeding
	Outcome	HIV-free survival

The Guideline Development Group also suggested examining the implications of updated recommendations on two programmatic areas:

What guidance on infant feeding should be provided to mothers living with HIV and to health authorities in conflict or emergency settings?
What are the implications for monitoring and evaluation?

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Guideline: Updates on HIV and Infant Feeding: The Duration of Breastfeeding, and Support from Health Services to Improve Feeding Practices Among Mothers Living with HIV. Geneva: World Health Organization; 2016. Annex 5, Questions and PICO used as the basis for preparing systematic reviews of the available published evidence.
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