The role of evidence in the development of treatment recommendations: application of the GRADE criteria to breast-feeding HIV-positive mothers

Over the last several decades, the role of clinical medicine in the development of practice guidelines has increasingly` become dependent upon evidence. This study aims to examine the role evidence played in the development of the treatment guidelines concerning infant feeding options for babies born to HIV-infected mothers in Sub-Saharan Africa. Clinical outcome data was reviewed from the evidence available from the World Health Organization. Outcomes of interest were assessed based upon the infants either being exclusively breastfed or exclusively formula fed with the relative risks of these outcomes given the exposure calculated and the evidence graded for its strengths and deficiencies within the framework of GRADE. The findings suggest that the evidence had some methodological flaws as well as inconsistencies that resulted in low quality grading. The clinical community would benefit from further research that will likely have an important influence on the confidence of the study estimates.