scholarly journals Patterns of changing pregnancy intentions among women living with HIV in Canada

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lashanda Skerritt ◽  
Angela Kaida ◽  
Nadia O’Brien ◽  
Ann N. Burchell ◽  
Gillian Bartlett ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Healthcare Providers ◽  
Undetectable Viral Load ◽  
Subsequent Pregnancy ◽  
Reproductive Age ◽  
Pregnancy Intentions ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Health Cohort Study

Abstract Background Women with an undetectable viral load can become pregnant and have children with no risk of HIV transmission to their sexual partners and low risk of transmission to their infants. Contemporary pregnancy intentions of women living with HIV in Canada are poorly understood, evidenced by high rates of unintended pregnancy and low uptake of contraceptives. Methods We used longitudinal survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to measure and compare pregnancy intentions (Yes vs No vs Unsure) at baseline, 18-months and 36-months follow-up (from 2013 to 2018) among women living with HIV of reproductive age (16–49 years) and potential. We used Sankey diagrams to depict changes in pregnancy intentions over time and multivariable logistic regression to examine the relationship between pregnancy intention within 2 years and subsequent pregnancy. Results At baseline, 41.9% (119/284) of women intended to become pregnant, 43.3% did not, and 14.8% were unsure. Across 36-months of follow-up, 41.9% (119/284) of women changed their pregnancy intentions, with 25% changing from intending to not intending to become pregnant and 13.1% vice versa. Pregnancy intentions were not strongly associated with subsequent pregnancy between baseline and 18-months (aOR 1.44; 95% CI 0.53, 3.72) or between 18 and 36-months (aOR 2.17; 95% CI 0.92, 5.13). Conclusions Our findings underscore the need for healthcare providers to engage in ongoing discussions with women living with HIV to support their dynamic pregnancy intentions.

Breastfeeding by Women Living With Human Immunodeficiency Virus in a Resource-Rich Setting: A Case Series of Maternal and Infant Management and Outcomes

2019 ◽  
Vol 9 (2) ◽  
pp. 228-231 ◽  
Author(s):  
N Nashid ◽  
S Khan ◽  
M Loutfy ◽  
J MacGillivray ◽  
M H Yudin ◽  
...  
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Case Series ◽  
Virologic Suppression ◽  
Combination Antiretroviral Therapy ◽  
Breastfed Infants ◽  
Women Living With Hiv ◽  
Immunodeficiency Virus ◽  
Living With Hiv

Abstract The reduction in human immunodeficiency virus (HIV) transmission through breastmilk with maternal combination antiretroviral therapy (cART) has led many pregnant women living with HIV and healthcare providers to question exclusive formula feeding in resource-rich settings. Here, we describe cART prophylaxis in 3 breastfed infants whose mothers had sustained virologic suppression; all 3 of these infants remained uninfected.

scholarly journals Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gloria Katuta Mayondi ◽  
Aamirah Mussa ◽  
Rebecca Zash ◽  
Sikhulile Moyo ◽  
Arielle Issacson ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Feeding Method ◽  
Hiv Rna ◽  
Women Living With Hiv ◽  
Feeding Choice ◽  
Infant Feeding Decisions ◽  
Living With Hiv ◽  
Mother To Child

Abstract Background Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy. Methods From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice. Results Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy. Conclusions In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.

scholarly journals Women of Reproductive Age Living with HIV in Argentina: Unique Challenges for Reengagement in Care

2019 ◽  
Vol 18 ◽  
pp. 232595821988325
Author(s):  
Diego Cecchini ◽  
Maria Luisa Alcaide ◽  
Violeta de Jesus Rodriguez ◽  
Lissa Nicole Mandell ◽  
John Michael Abbamonte ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Latent Class ◽  
Hiv Transmission ◽  
Reproductive Age ◽  
Hiv Care ◽  
Women Of Reproductive Age ◽  
Physician Visits ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Disproportionate Burden

This study evaluated the reasons for not taking antiretroviral treatment (ART) among women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups and physician visits), with the goal of identifying strategies for reengagement in HIV care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who completed sociodemographic, medical history, reasons why they were not taking ART, mental health, motivation, and self-efficacy assessments. Latent class analysis was used for analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher depression ( U = 608.5, z = −2.7, P = .007), lower motivation ( U = 601, z = −2.8, P = .006), and lower self-efficacy ( U = 644.5, z = −2.4, P = .017) than those not using this maladaptive strategy. As women living with HIV experience a disproportionate burden of poor health outcomes, interventions focused on the management of depression may improve HIV outcomes and prevent HIV transmission.

HIV in pregnant women and prevention of perinatal transmission

2015 ◽  
Vol 36 (4) ◽  
pp. 182
Author(s):  
Michelle Giles
Keyword(s):  
Hiv Transmission ◽  
Reproductive Rights ◽  
Post Partum ◽  
Undetectable Viral Load ◽  
Perinatal Transmission ◽  
Access To Treatment ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Uninfected Infant ◽  
Living With Hiv

Women with HIV who have access to treatment can expect to have a normal life expectancy. With effective antiretroviral therapy, an undetectable viral load, and avoidance of breastfeeding, the rate of perinatal transmission is extremely low (&lt;1%). A Caesarean section is no longer routinely recommended nor is intrapartum zidovudine. Women living with HIV should be supported in their decision regarding parenthood given their excellent prognosis, low risk of perinatal transmission and reproductive rights. If interventions to reduce perinatal HIV transmission during pregnancy and post-partum are embraced, women can expect to have an uninfected infant.

scholarly journals Breastfeeding with HIV: An Evidence-Based Case for New Policy

2019 ◽  
Vol 47 (1) ◽  
pp. 152-160 ◽  
Author(s):  
Marielle S. Gross ◽  
Holly A. Taylor ◽  
Cecilia Tomori ◽  
Jenell S. Coleman
Keyword(s):  
Viral Load ◽  
Harm Reduction ◽  
Hiv Transmission ◽  
Undetectable Viral Load ◽  
Perinatal Transmission ◽  
Sudden Infant ◽  
National Guidelines ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Living With Hiv

To help eliminate perinatal HIV transmission, the US Department of Health and Human Services recommends against breastfeeding for women living with HIV, regardless of viral load or combined antiretroviral therapy (cART) status. However, cART radically improves HIV prognosis and virtually eliminates perinatal transmission, and breastfeeding's health benefits are well-established. In this setting, pregnancy is increasing among American women with HIV, and a harm reduction approach to those who breastfeed despite extensive counseling is suggested. We assess the evidence and ethical justification for current policy, with attention to pertinent racial and health disparities. We first review perinatal transmission and breastfeeding data relevant to US infants. We compare hypothetical risk of HIV transmission from breastmilk to increased mortality from sudden infant death syndrome, necrotizing enterocolitis and sepsis from avoiding breastfeeding, finding that benefits may outweigh risks if mothers maintain undetectable viral load on cART. We then review maternal health considerations. We conclude that avoidance of breastfeeding by women living with HIV may not maximize health outcomes and discuss our recommendation for revising national guidelines in light of autonomy, harm reduction and health inequities.

scholarly journals Unmet need for family planning and factors associated among women living with HIV in Oromia regional state, Ethiopia

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Dereje Bayissa Demissie ◽  
Gizachew Abdissa Bulto ◽  
Rose Mmusi-Phetoe
Keyword(s):  
Family Planning ◽  
Healthcare Providers ◽  
Unmet Need ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Women Living With Hiv ◽  
Regional State ◽  
Future Fertility ◽  
Met Needs ◽  
Living With Hiv

Abstract Objectives The purpose of this study was to determine the prevalence of the unmet need and identifying factors associated with the unmet need among women of reproductive age living with HIV in Oromia regional state, Ethiopia. One critical component of both a full range of contraceptives and satisfying demand for family planning with HIV services all women living with HIV is the appropriate model for HIV therapy, HIV prevention, and care with family planning services in a resource-limiting area like Ethiopia. Methods Health facility-based cross-sectional study design was conducted among women living with HIV attending ART clinics in the special zone of, Oromia regional state, by simple random sampling was used to select 654 respondents. Both bivariate and multivariable logistic regressions analysis was used to identify at adjusted odds ratio (AOR) with 95% CI in the final model. Result The study assessed the magnitude of demand for family planning among HIV-infected women and established that the demand was 630 (96.3%), of which 100 (16%) of women of reproductive age living with HIV had unmet needs for family planning while attending monthly ART clinic drug refilling and follow up. This study identified that factors found to be associated with met needs for family planning among women of reproductive age living with HIV attending ART/PMTC were discussions with healthcare providers (AOR = 4.33, 95% CI 2.56–7.32), previous pregnancy (AOR = 3.07, 95% CI 1.84–5.12); future fertility desire (AOR = 2.15, 95% CI 1.31–3.51); having sexual partners (AOR = 5.26, 95% CI 1.79–15.5) and the number of the sexual partner (one) (AOR = 7.24, 95% CI 1.82–28.74) were identified independent predictors of met needs for family planning. Conclusion The overall demand for family planning was 96% among the women living with HIV, and that 16% of women had an unmet need for family planning. The authors conducted a logistic regression and find various dependent variables that are associated with the met need for family planning services, such as having discussions with healthcare providers, having a partner and previous pregnancy; future fertility desire, the last pregnancy being intended. These results are interpreted to suggest that clear policy implications of family planning must be better integrated into ART clinics.

scholarly journals Preconception and Contraceptive Care for Women Living with HIV

2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
Mary Jo Hoyt ◽  
Deborah S. Storm ◽  
Erika Aaron ◽  
Jean Anderson
Keyword(s):  
Hiv Transmission ◽  
Unmet Need ◽  
Reproductive Age ◽  
Fertility Desires ◽  
Women Living With Hiv ◽  
Perinatal Hiv ◽  
Specialized Care ◽  
Fertility Data ◽  
Primary Focus ◽  
Living With Hiv

Women living with HIV have fertility desires and intentions that are similar to those of uninfected women, and with advances in treatment most women can realistically plan to have and raise children to adulthood. Although HIV may have adverse effects on fertility, recent studies suggest that antiretroviral therapy may increase or restore fertility. Data indicate the increasing numbers of women living with HIV who are becoming pregnant, and that many pregnancies are unintended and contraception is underutilized, reflecting an unmet need for preconception care (PCC). In addition to the PCC appropriate for all women of reproductive age, women living with HIV require comprehensive, specialized care that addresses their unique needs. The goals of PCC for women living with HIV are to prevent unintended pregnancy, optimize maternal health prior to pregnancy, improve maternal and fetal outcomes in pregnancy, prevent perinatal HIV transmission, and prevent HIV transmission to an HIV-uninfected sexual partner when trying to conceive. This paper discusses the rationale for preconception counseling and care in the setting of HIV and reviews current literature relevant to the content and considerations in providing PCC for women living with HIV, with a primary focus on well-resourced settings.

scholarly journals Discussing reproductive goals with healthcare providers among women living with HIV in Canada: the role of provider gender and patient comfort

2021 ◽  
Vol 29 (1) ◽  
pp. 1932702
Author(s):  
Lashanda Skerritt ◽  
Alexandra de Pokomandy ◽  
Nadia O’Brien ◽  
Nadia Sourial ◽  
Ann N Burchell ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Patient Comfort ◽  
Women Living With Hiv ◽  
Living With Hiv

Antiretroviral Therapy in Pregnant Women

2019 ◽  
pp. 281-286
Author(s):  
William R. Short ◽  
Jason J. Schafer
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Pediatric Aids ◽  
Women Living With Hiv ◽  
Pivotal Study ◽  
Aids Clinical Trials ◽  
Living With Hiv ◽  
Mother To Child ◽  
Over Time

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV. Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...

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