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Benson J, Pierre C, Joseph NT. Updates in the Management of HIV During Pregnancy. Clin Obstet Gynecol 2024; 67:644-651. [PMID: 38946602 DOI: 10.1097/grf.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Human immunodeficiency virus in pregnant people remains a significant public health issue worldwide. The rate of perinatal transmission is 15% to 40% but can be decreased to less than 1% with appropriate antenatal management. Previous recommendations included a protease inhibitor-based antiretroviral therapy, infant prophylaxis, performance of cesarean section for uncontrolled viremia, and the use of formula for infant feeding. However, recent updates include first line of integrase inhibitor-based regimens and supporting parental choices for safe lactation. In this review, we summarize and provide updated recommendations for the care of people living with human immunodeficiency virus during pregnancy.
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Affiliation(s)
- Jemma Benson
- Division of Infectious Disease, Department of Medicine, Boston University School of Medicine
| | - Cassandra Pierre
- Division of Infectious Disease, Department of Medicine, Boston University School of Medicine
| | - Naima T Joseph
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
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Unternaher J, Koay WLA, Mareuil J, Williams T, Rakhmanina N. Progress in Eliminating Perinatal HIV Transmission in the Metropolitan DC Area Between 2018-2022. J Acquir Immune Defic Syndr 2024; 97:6-12. [PMID: 39116327 DOI: 10.1097/qai.0000000000003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/10/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND The number of perinatal HIV cases have continued to decline since the United States achieved the goal of perinatal HIV elimination in 2019. We aimed to evaluate dynamics in perinatal HIV transmission in the metropolitan District of Columbia (DC) area during 2018-2022. SETTING Children's National Hospital's (CNH) is a major referral site for the metropolitan DC area, including suburban Maryland and Virginia, and evaluates >95% of HIV-exposed infants (HEI) in the region. METHODS A retrospective cohort study of mother-infant pairs with perinatal HIV exposure seen at CNH during 2018-2022. We describe the demographics, intrapartum/postpartum management, and outcomes among mothers and HEI. RESULTS We analyzed 503 HEI; most (78.9%) were at low risk for perinatal HIV. Most mothers were African or African American (87.1%) and had HIV RNA <50 copies/mL around delivery (78.1%). The proportion of HEI at high risk for perinatal HIV decreased from 28.2% to 15.5% in 2018 and 2020, respectively, but increased to 24.8% in 2022. Most HEI received postnatal antiretroviral drugs for at least 4 weeks (95.3%). Seventy-nine infants (15.7%) were born to mothers diagnosed with HIV during pregnancy. Two infants (0.4%) were diagnosed with perinatally acquired HIV. CONCLUSIONS We report high rates of antiretroviral drugs use among mother-infant pairs and a low rate of perinatal HIV transmission in metropolitan DC. Despite a 1.8-fold decrease in the number of high-risk perinatal HIV exposures since 2018, this rate rebounded in 2022. There remain opportunities to optimize maternal care and reduce the number of high-risk HEI.
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Affiliation(s)
- Justin Unternaher
- Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC
| | - Wei Li A Koay
- Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC
- Department of Pediatrics, The School of Medicine and Health Sciences, George Washington University, Washington, DC
- Currently, Department of Pediatrics, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC
| | - Joanna Mareuil
- Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC
- Currently, Division of Hematology, Children's National Hospital, Washington, DC; and
| | - Tierra Williams
- Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC
| | - Natella Rakhmanina
- Division of Pediatric Infectious Diseases, Children's National Hospital, Washington, DC
- Department of Pediatrics, The School of Medicine and Health Sciences, George Washington University, Washington, DC
- Technical Strategies and Innovation, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
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Espinal M, Yee LM, Fisher SA. Advances in HIV Management During Pregnancy and Infant Feeding. Infect Dis Clin North Am 2024; 38:423-452. [PMID: 38969531 DOI: 10.1016/j.idc.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
Recent advances in human immunodeficiency virus (HIV) management during pregnancy and infant feeding encompass several key elements: expanded HIV testing guidance; growing evidence of safety, efficacy, and pharmacokinetic data favoring the use of preferred antiretroviral therapy (ART) during pregnancy and breastfeeding; increasing advocacy for the inclusion of pregnant individuals with HIV in clinical trials to expedite access to new ART; and updated guidelines supporting shared decision-making for choice of infant feeding methods in people with HIV.
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Affiliation(s)
- Mariana Espinal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA.
| | - Stephanie A Fisher
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 East Superior Street, Suite 05-2303, Chicago, IL, USA
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Abuogi L, Noble L, Smith C. Infant Feeding for Persons Living With and at Risk for HIV in the United States: Clinical Report. Pediatrics 2024; 153:e2024066843. [PMID: 38766700 DOI: 10.1542/peds.2024-066843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/22/2024] Open
Abstract
Pediatricians and pediatric health care professionals caring for infants born to people living with and at risk for HIV infection are likely to be involved in providing guidance on recommended infant feeding practices. Care team members need to be aware of the HIV transmission risk from breastfeeding and the recommendations for feeding infants with perinatal HIV exposure in the United States. The risk of HIV transmission via breastfeeding from a parent with HIV who is receiving antiretroviral treatment (ART) and is virally suppressed is estimated to be less than 1%. The American Academy of Pediatrics recommends that for people with HIV in the United States, avoidance of breastfeeding is the only infant feeding option with 0% risk of HIV transmission. However, people with HIV may express a desire to breastfeed, and pediatricians should be prepared to offer a family-centered, nonjudgmental, harm reduction approach to support people with HIV on ART with sustained viral suppression below 50 copies per mL who desire to breastfeed. Pediatric health care professionals who counsel people with HIV who are not on ART or who are on ART but without viral suppression should recommend against breastfeeding. Pediatric health care professionals should recommend HIV testing for all pregnant persons and HIV preexposure prophylaxis to pregnant or breastfeeding persons who test negative for HIV but are at high risk of HIV acquisition.
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Affiliation(s)
- Lisa Abuogi
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Lawrence Noble
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York
| | - Christiana Smith
- Section of Infectious Diseases, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
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Djiadeu P, Begum H, Archibald C, Ekmekjian T, Busa G, Dansoh J, Van Nguyen P, Merckx J, Fleurant A. Risk of transmission of HIV to infants during breast/chest feeding when mothers/birthing parents living with HIV are on antiretroviral therapy: a protocol for a rapid review. BMJ Open 2024; 14:e084436. [PMID: 38719325 PMCID: PMC11086518 DOI: 10.1136/bmjopen-2024-084436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION HIV is a major public health issue affecting millions globally. Women and girls account for 46% of new HIV infections in 2022 and approximately 1.3 million females become pregnant every year. Vertical transmission of HIV from persons living with HIV (PLHIV) to infants may occur through different modalities, such as through breast/chest feeding. Notably, 82% of PLHIV who chose to breast/chest feed are on antiretroviral therapy (ART) when feeding their infants. Precise estimates of the risk of postpartum transmission to infants during breast/chest feeding at varying viral load levels remain a significant gap in the literature. METHODS AND ANALYSIS A rapid systematic search of electronic databases will be conducted from January 2005 to the present, including Medline, Embase and Global Health. The objective of this rapid review is to explore and assess the available evidence on the effect of varying viral load levels on the risk of HIV transmission to infants during breast/chest feeding when the birthing or gestational parent living with HIV is on ART. Study characteristics will be summarised and reported to support the narrative summary of the findings. The focus will be on the absolute risk of HIV transmission from birthing parent to infant during chest/breast feeding. The findings will also be stratified by month, including the risk of HIV transmission for 6 months and greater than 6 months postpartum. We will ascertain the risk of bias using A Measurement Tool to Assess Systematic Reviews 2, Quality of Prognosis Studies and Downs and Black checklist for the appropriate study type. A summary score will not be calculated, rather the strengths and limitations of the studies will be narratively described. ETHICS AND DISSEMINATION No human subjects will be involved in the research. The findings of this rapid review will inform a future systematic review and will be disseminated through peer-reviewed publications, presentations and conferences. PROSPERO REGISTRATION NUMBER CRD42024499393.
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Affiliation(s)
- Pascal Djiadeu
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Housne Begum
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Chris Archibald
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Giovanna Busa
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeffery Dansoh
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Phu Van Nguyen
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Joanna Merckx
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Annie Fleurant
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- STBBI Guidance, Public Health Agency of Canada, Ottawa, Ontario, Canada
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Harris LR, Lee DH, Mareuil JW, Rakhmanina NY, Koay WLA. The Mental Health Effects and Experiences of Breastfeeding Decision-Making Among Postpartum Women Living with HIV. AIDS Behav 2024; 28:1186-1196. [PMID: 37505338 DOI: 10.1007/s10461-023-04142-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Prior to January 2023, women living with HIV (WLWH) in the United States (US) were discouraged from breastfeeding due to the potential risk of mother-to-child HIV transmission through breastfeeding. Lack of breastfeeding decision-making and experience among WLWH may negatively affect maternal mental health. We implemented a quality improvement initiative to screen WLWH for postpartum depression (PPD), evaluate their attitudes toward breastfeeding, and assess their experience with breastfeeding decision-making. We collected quantitative data from WLWH using a voluntary, self-administered 6-item breastfeeding decision-making and experience survey (administered 1 month postpartum) and a 10-item Edinburgh Postnatal Depression Scale (EPDS, negative = 0-9; administered 1 and 4 months postpartum) tool. We conducted descriptive statistics and cross tabulation analysis. We analyzed 106 WLWH (93.4% non-Hispanic Black/African American; mean age 33.1 years; 82.1% HIV RNA < 200 copies/mL). One in five (19.1%) WLWH had a positive baseline EPDS screen, with the mean EPDS scores decreasing from 5.3 ± 5.4 (baseline) to 4.6 ± 4.8 (follow-up). Among 55 WLWH who provided baseline and follow-up EPDS scores, only 3/13 with a positive baseline EPDS screen had resolved depressive symptoms at follow-up. Over one-third (37.7%) of WLWH indicated feeling "sadness" when asked whether lack of breastfeeding negatively affected their feelings or emotions. Over half of WLWH (51.9%) were aware of the US breastfeeding recommendations, but the majority (60.4%) had never discussed breastfeeding options with a medical provider. Improved provider-patient discussions on infant feeding options among WLWH is needed to increase awareness of breastfeeding choices and promote informed, autonomous breastfeeding decision-making among WLWH.
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Affiliation(s)
- Leah R Harris
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- General Dynamics Information Technology, Washington, DC, USA
| | - Do H Lee
- Department of Biostatistics and Bioinformatics, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Joanna W Mareuil
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
| | - Natella Y Rakhmanina
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Technical Strategies and Innovation, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Wei Li A Koay
- Division of Infectious Diseases, Children's National Hospital, Washington, DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
- Children's National Hospital, 111 Michigan Ave NW, West Wing Level 3.5 Suite 100, Washington, DC, 20010, USA.
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Bamford A, Foster C, Lyall H. Infant feeding: emerging concepts to prevent HIV transmission. Curr Opin Infect Dis 2024; 37:8-16. [PMID: 37889586 PMCID: PMC10734781 DOI: 10.1097/qco.0000000000000986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
PURPOSE OF REVIEW HIV screening in pregnancy, universal suppressive antiretroviral therapy (ART) and breastfeeding avoidance can almost completely prevent vertical transmission of HIV. Breastfeeding is associated with an additional risk of transmission, although this risk is extremely low with suppressive maternal ART. This minimal risk must be balanced with the benefits of breastfeeding for women living with HIV (WLHIV) and their infants. Guidance in high-income countries has evolved, moving towards supported breast feeding for women on suppressive ART. RECENT FINDINGS Breastmilk transmission accounts for an increasing proportion of new infant infections globally. The majority of transmission data comes from studies including women not on suppressive ART. Breastmilk transmissions in the context of undetectable viral load have rarely occurred, although risk factors remain unclear. Outcome data on supported breastfeeding are accumulating, providing evidence for guidelines and informing infant feeding decisions. Long-acting ART for maternal preexposure prophylaxis or treatment, and infant postnatal prophylaxis are promising future options. SUMMARY Breastfeeding on suppressive ART has a very low risk of vertical transmission and can have multiple benefits for WLHIV and their infants. However, caution is advised with relaxation of breastfeeding guidance so as not to jeopardise the global goal of elimination of vertical transmission by 2030.
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Affiliation(s)
- Alasdair Bamford
- Great Ormond Street Hospital for Children NHS Foundation Trust
- UCL Great Ormond Street Institute of Child Health
- MRC Clinical Trials Unit at UCL
| | - Caroline Foster
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
| | - Hermione Lyall
- Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK
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Levison J, McKinney J, Duque A, Hawkins J, Bowden EVH, Dorland J, Bitnun A, Kazmi K, Campbell DM, MacGillivray J, Yudin MH, Powell A, Datta S, Abuogi L, Weinberg A, Rakhmanina N, Mareuil JW, Hitti J, Boucoiran I, Kakkar F, Rahangdale L, Seidman D, Widener R. Breastfeeding Among People With Human Immunodeficiency Virus in North America: A Multisite Study. Clin Infect Dis 2023; 77:1416-1422. [PMID: 37078712 PMCID: PMC10654886 DOI: 10.1093/cid/ciad235] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND In North American countries, national guidelines have strongly recommended formula over breastmilk for people with human immunodeficiency virus (HIV) because of concern for HIV transmission. However, data from resource-limited settings suggest the risk is <1% among virally suppressed people. Information regarding breastfeeding experience in high-resource settings is lacking. METHODS A retrospective multisite study was performed for individuals with HIV who breastfed during 2014-2022 in the United States (8 sites) and Canada (3 sites). Descriptive statistics were used for data analysis. RESULTS Among the 72 cases reported, most had been diagnosed with HIV and were on antiretroviral therapy prior to the index pregnancy and had undetectable viral loads at delivery. Most commonly reported reasons for choosing to breastfeed were health benefits, community expectations, and parent-child bonding. Median duration of breastfeeding was 24 weeks (range, 1 day to 72 weeks). Regimens for infant prophylaxis and protocols for testing of infants and birthing parents varied widely among institutions. No neonatal transmissions occurred among the 94% of infants for whom results were available ≥6 weeks after weaning. CONCLUSIONS This study describes the largest cohort to date of people with HIV who breastfed in North America. Findings demonstrate high variability among institutions in policies, infant prophylaxis, and infant and parental testing practices. The study describes challenges in weighing the potential risks of transmission with personal and community factors. Finally, this study highlights the relatively small numbers of patients with HIV who chose to breastfeed at any 1 location, and the need for further multisite studies to identify best care practices.
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Affiliation(s)
- Judy Levison
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer McKinney
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alejandra Duque
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Joanna Hawkins
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Emily Ver Hoeve Bowden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Julie Dorland
- Department of Obstetrics and Gynecology, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Kescha Kazmi
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, Toronto, Canada
| | - Douglas M Campbell
- Department of Pediatrics, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Jay MacGillivray
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Mark H Yudin
- Department of Obstetrics and Gynecology, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Anna Powell
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Shreetoma Datta
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lisa Abuogi
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Adriana Weinberg
- Department of Pediatrics, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Natella Rakhmanina
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Joanna Walsh Mareuil
- Department of Pediatrics, Children's National Hospital, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jane Hitti
- Department of Maternal Fetal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynecology, University of Montreal/Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Fatima Kakkar
- Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Lisa Rahangdale
- Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Dominika Seidman
- Department of Obstetrics and Gynecology, University of California San Francisco, San Francisco, California, USA
| | - Rebecca Widener
- Department of Pediatrics, University of South Carolina School of Medicine, Columbia, South Carolina, USA
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Clark RRS, Burwell N, Louis MJ, Philips JA. Research and Professional Literature to Inform Practice, November/December 2023. J Midwifery Womens Health 2023; 68:787-791. [PMID: 38087870 DOI: 10.1111/jmwh.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/27/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Rebecca R S Clark
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- Pennsylvania Hospital, Philadelphia, Pennsylvania
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Pagano-Therrien J, Griswold MK, Amoah RK. "Go With the Flow": A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States. J Assoc Nurses AIDS Care 2023; 34:376-388. [PMID: 37199426 DOI: 10.1097/jnc.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
ABSTRACT Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother-infant dyad.
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Affiliation(s)
- Jesica Pagano-Therrien
- Jesica Pagano-Therrien, PhD, RN, CPNP-PC is an Associate Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA. Michele K. Griswold, PhD, MPH, RN, IBCLC is an Assistant Professor, Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, USA. Rita Amoah, PhD, RN, is an Assistant Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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