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 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.

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% (...

scholarly journals HIV Status and Contraceptive Utilization among Women in Cameroon

2019 ◽  
Vol 18 ◽  
pp. 232595821982659 ◽  
Author(s):  
Henna Budhwani ◽  
Kristine Ria Hearld ◽  
Jodie Dionne-Odom ◽  
Simon Manga ◽  
Kathleen Nulah ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Hiv Transmission ◽  
Multivariate Analyses ◽  
Hiv Status ◽  
Improve Population Health ◽  
Women Living With Hiv ◽  
Contraceptive Utilization ◽  
Living With Hiv ◽  
Mother To Child ◽  
Hiv Negative

Objective: We examined patterns of contraceptive utilization by HIV status among women in Cameroon, hypothesizing that women living with HIV would utilize contraception at higher rates than their HIV-negative peers. Methods: Deidentified, clinical data from the Cameroon Baptist Convention Health Services (2007-2013) were analyzed (N = 8995). Frequencies compared outcomes between women living with HIV (15.1%) and uninfected women. Multivariate analyses examined associates of contraceptive utilization and desire to become pregnant. Results: Contraceptive utilization was associated with higher education, living with HIV, monogamy, and higher parity ( P < .001). Women living with HIV had 66% higher odds of using contraceptives than their negative peers (odds ratio [OR]: 1.66, confidence interval [CI]: 1.45-1.91, P < .001). Polygamous women had 37% lower odds of using contraceptives compared to monogamous women (OR: 0.63, 95% CI: 0.52-0.75, P < .001). Conclusion: Increasing contraceptive utilization in resource-constrained settings should be a priority for clinicians and researchers. Doing so could improve population health by reducing HIV transmission between partners and from mother to child.

scholarly journals Feedback-guided Development for Patient Education Animation: HIV Transmission via Breastfeeding

2018 ◽  
Vol 42 (2) ◽  
Author(s):  
Sarah Crawley ◽  
Shelley Wall ◽  
Lena Serghides ◽  
Marc Dryer
Keyword(s):  
Patient Education ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Culturally Sensitive ◽  
Target Audience ◽  
Transmission Risk ◽  
User Testing ◽  
Living With Hiv ◽  
Direct Feedback ◽  
Mother To Child

This thesis project uses animation to communicate the risk of HIV transmission via breastfeeding to mothers living with HIV in Canada. Current guidelines do not recommend breastfeeding for HIV+ mothers because there is always some level of risk. Knowledge of mother-to-child transmission is poor, and the cultural pressure to breastfeed has complex implications. It was essential that the science of transmission risk be conveyed in a clear and culturally sensitive manner, to allow women to make appropriate, informed decisions about whether or not to breastfeed. To accomplish this, we adopted a user-testing approach. Throughout development, the script, animatic, and character designs were presented for feedback to members of the target audience, healthcare providers, and representatives from Canadian HIV organizations in an iterative design process. At each round of feedback, the script, animatic, and visual assets were revised, and sent for further comment. Ongoing collaboration with the target audience helped us develop an animation with a wide diversity of characters, culturally sensitive metaphors, and nuanced descriptions of risk, in response to feedback that detailed desires about representation and identified how concepts were being misunderstood. User-testing approaches are necessary when creating patient education animations. Population needs, background, and context have a dramatic impact on patient understanding, and cannot be understood properly without user testing and direct feedback. Doing so helps prevent insensitive concepts and easily misinterpreted information, and thus is key to effective patient education animation.

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 Comprehensive nationwide analysis of mother-to-child HIV transmission in Finland from 1983 to 2013

2018 ◽  
Vol 146 (10) ◽  
pp. 1301-1307 ◽  
Author(s):  
I. Aho ◽  
P. Kivelä ◽  
M. Kaijomaa ◽  
H.-M. Surcel ◽  
M. Ristola ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Sexual Transmission ◽  
Easy Access ◽  
Hiv Positive ◽  
Hiv Diagnosis ◽  
Women Living With Hiv ◽  
Similar Good ◽  
Low Prevalence ◽  
Living With Hiv ◽  
Mother To Child

AbstractHIV-positive children are still born in Europe despite low mother-to-child transmission (MTCT) rates. We aimed to clarify the remaining barriers to the prevention of MTCT. By combining the national registers, we identified all women living with HIV delivering at least one child during 1983–2013. Of the 212 women delivering after HIV diagnosis, 46% were diagnosed during the pregnancy. In multivariate analysis, age >30 years (P = 0.001), sexual transmission (P = 0.012), living outside of the metropolitan area (P = 0.001) and Eastern European origin (P = 0.043) were risk factors for missed diagnosis before pregnancy. The proportion of immigrants increased from 18% before 1999 to 75% during 2011–2013 (P < 0.001). They were diagnosed during the pregnancy equally to natives and achieved similar, good treatment results. No MTCT occurred when the mother was diagnosed before the delivery. In addition, 12 women had delivered in 2 years prior their HIV diagnosis, most before implementation of the national screening of pregnant women. Three of these children were infected, the last one in 2000. Our data demonstrate that complete elimination of MTCT is feasible in a high-income, low-prevalence country. This requires ongoing universal screening in early pregnancy and easy access to antiretroviral therapy to all HIV-positive people.

Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis

2020 ◽  
Vol 36 (1) ◽  
pp. 44-52
Author(s):  
Michele K. Griswold ◽  
Jesica Pagano-Therrien
Keyword(s):  
Infant Feeding ◽  
Healthcare Professionals ◽  
High Income ◽  
Social And Emotional ◽  
Women Living With Hiv ◽  
Clinical Recommendation ◽  
Self Worth ◽  
Evidenced Based ◽  
Infant Feeding Decisions ◽  
Living With Hiv

Background: Recommendations to avoid breastfeeding for women living with HIV in high income countries has resulted in a gap in the literature on how healthcare professionals can provide the highest standard of lactation counseling. Research aims: (1) Describe social and emotional experiences of infant feeding for women living with HIV in high income countries; (2) raise ethical considerations surrounding the clinical recommendation in high income countries to avoid breastfeeding. Methods: A systematic literature search was conducted between January 1, 2008 and June 20, 2019. A total of 900 papers were screened and six met the inclusion criteria: (a) the sample was drawn from a high-income country regardless of the nativity of participants; (b) some or all participants were women living with HIV. Metasynthesis, according to Noblit and Hare (1988), was used to synthesize the experiences of women living with HIV in high-income countries and their experiences in infant feeding decisions. Results: Participants in this sample suffered a substantial emotional burden associated with infant feeding experiences potentially leading to risk of internalized stigma, suggesting that infant feeding considerations may contribute to HIV stigma in unique ways. Four overarching themes were identified expressing the meaning of avoidance of breastfeeding: maternal self-worth, deculturalization, surveillance, and intersectionality. Conclusion: Women in high-income countries living with HIV deserve the highest standard of lactation care and counseling available. Healthcare professionals in high-income countries are ethically obligated to provide evidenced-based lactation care and counseling to women living with HIV.

Surviving Surveillance: How Pregnant Women and Mothers Living With HIV Respond to Medical and Social Surveillance

2017 ◽  
Vol 27 (14) ◽  
pp. 2088-2099 ◽  
Author(s):  
Saara Greene ◽  
Allyson Ion ◽  
Gladys Kwaramba ◽  
Lisa Lazarus ◽  
Mona Loutfy
Keyword(s):  
Pregnant Women ◽  
Infant Feeding ◽  
Hiv Transmission ◽  
Service Providers ◽  
Negative Impact ◽  
Infant Feeding Practices ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv ◽  
The Relationship

Pregnant women and mothers living with HIV are under surveillance of service providers, family members, and the community at large. Surveillance occurs throughout the medical management of their HIV during pregnancy, preventing HIV transmission to their baby, infant feeding practices, and as part of assessments related to their ability to mother. Enacted and anticipatory HIV-related stigma can exacerbate the negative impact that being under surveillance has on mothers living with HIV as they move through their pregnancy, birthing, and mothering experiences. In response, women living with HIV find ways to manage their experiences of surveillance through engaging in acts of distancing, planning, and resisting at different points in time, and sometimes enacting all three practices at once. Positioning the narratives of pregnant women and mothers living with HIV in relation to their experiences of surveillance illuminates the relationship between the surveillance of mothers living with HIV and HIV-related stigma.

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

scholarly journals Burden of HIV-Related Stigma and Post-Partum Depression: A Cross-Sectional Study of Patients Attending Prevention of Mother-to-Child Transmission Clinic at Kenyatta National Hospital in Nairobi

2021 ◽  
Vol 11 ◽  
Author(s):  
Obadia Yator ◽  
Muthoni Mathai ◽  
Tele Albert ◽  
Manasi Kumar
Keyword(s):  
Postpartum Depression ◽  
Post Partum ◽  
Internalized Stigma ◽  
Child Transmission ◽  
National Hospital ◽  
Cross Sectional ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv ◽  
Mother To Child

Background: We look at how various HIV-related stigma subtypes, especially internalizing types, interact with postpartum depression (PPD) among women living with HIV. Additionally, we identify key psychosocial risk factors that influence stigma and PPD among women attending Prevention of Mother-to-Child Transmission (PMTCT) clinics.Methods: In this cross-sectional design, 123 women living with HIV were recruited. Participants ages between 18 and 50, who were at least 8 weeks postpartum seeking PMTCT services at Kenyatta National Hospital (KNH), between June and September 2014 participated in the study. HIV/AIDS Stigma Instrument—PLWHA (HASI–P) was used to assesses stigma and Postpartum depression was assessed by Edinburgh Postnatal Depression Scale (EPDS). Bivariate and multivariate regression models were used to determine the individual characteristics associated with the HIV-related stigma Scale. Post survey a few in-depth-interviews were conducted to explore individuals' stigma and depression experiences.Results: The mean age was 31.2 years (SD = 5.2). Fifty-nine (48%) women screened positive for significant depressive symptoms. Post-partum depression was a significant predictor of internalized stigma, enacted, and total stigma (P &lt; 0.05). Older age was associated with less internalized stigma. Living with a partner was associated with more internalized stigma. Having an income above 100 USD per month was protective against stigma. Having good family social support was protective against internalized stigma. A higher educational level was protective against enacted stigma. Being treated for STIs was a risk factor for both enacted and overall stigma.Conclusions: HIV-related stigma needs to be addressed through integrated mental health care programs in PMTCT. Postpartum depression requires comprehensive management to improve short- and long-term outcomes of women living with HIV.

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