title: HIV testing in the maternity ward and the start of breastfeeding: a survival analysis.
abstract: OBJECTIVE
  The purpose of this study was to analyze the factors that influence of the time between birth and the beginning of breastfeeding, especially at the moment of the rapid HIV test results at hospital admission for delivery.
  
  
  METHODS
  Cohort study of 932 pregnant women who underwent rapid HIV test admitted in the hospital for delivery in Baby-Friendly Hospitals. The survival curves of time from birth to the first feeding were estimated by the Kaplan-Meier method and the joint effect of independent variables by the Cox model with a hierarchical analysis. As the survival curves were not homogeneous among the five hospitals, hindering the principle of proportionality of risks, the data were divided into two groups according to the median time of onset of breastfeeding at birth in women undergoing rapid HIV testing.
  
  
  RESULTS
  Hospitals with median time to breastfeeding onset at birth of up to 60 min were considered as early breastfeeding onset and those with higher medians were considered as late breastfeeding onset at birth. Risk factors common to hospitals considered to be with early and late breastfeeding onset at birth were: cesarean section (RR=1.75 [95% CI: 1.38-2.22]; RR=3.83 [95% CI: 3.03-4.85]) and rapid test result after birth (RR=1.45 [95% CI: 1.12-1.89]; RR=1.65 [95% CI: 1.35-2.02]), respectively; and hospitals with late onset: starting prenatal care in the third trimester (RR=1.86 [95% CI: 1.16-2.97]).
  
  
  CONCLUSIONS
  The onset of breastfeeding is postponed, even in Baby-Friendly Hospitals, when the results of the rapid HIV test requested in the maternity are not available at the time of delivery.
authors.affiliation: Department of Nursing, Universidade Estadual do Centro-Oeste (UNICENTRO), Guarapuava, PR, Brazil. Electronic address: glauciatalita@hotmail.com.
authors.forename: Glaucia T
authors.initials: GT
authors.lastname: Possolli
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Escola Nacional de Saúde Pública (ENSP), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, RJ, Brazil.
authors.forename: Márcia L de
authors.initials: ML
authors.lastname: Carvalho
authors.affiliation: Department of Epidemiology and Biostatistics, Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil.
authors.forename: Maria Inês C de
authors.initials: MI
authors.lastname: Oliveira
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D001942:Breast Feeding / Q000706:statistics & numerical data*; D002585:Cesarean Section / Q000009:adverse effects; D015331:Cohort Studies; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D013997:Time Factors
keywords: AIDS serodiagnosis; Aleitamento materno; Análise de sobrevida; Breastfeeding; Hospital birth; Nascimento em hospital; Sorodiagnóstico de AIDS; Survival analysis