Department of Infectious Diseases, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark.
Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Int Breastfeed J. 2024 Oct 11;19(1):71. doi: 10.1186/s13006-024-00677-2.
Recent changes in the infant feeding guidelines for women living with HIV from high-income countries recommend a more supportive approach focusing on shared decision-making. Limited information is available on the infant feeding knowledge of women living with HIV and how healthcare providers engage with them in this context. This multicenter, longitudinal, mixed methods study aims to get a comprehensive and nuanced understanding of infant feeding knowledge among women living with HIV of Nordic and non-Nordic origin living in Nordic countries, and their interaction with healthcare providers regarding infant feeding planning.
Pregnant women living with HIV in Denmark, Finland, and Sweden were recruited in 2019-2020. The Positive Attitudes Concerning Infant Feeding (PACIFY) questionnaire was completed in the 3rd trimester (T1), three (T2), and six (T3) months postpartum. Women who completed the quantitative survey were also invited to participate in qualitative semi-structured interviews at T1 and T3. Results from the survey and interviews were brought together through merging to assess for concordance, complementarity, expansion, or discordance between the datasets and to draw meta-inferences.
In total, 44 women living with HIV completed the survey, of whom 31 also participated in the interviews. The merged analyses identified two overarching domains: Knowledge about breastfeeding in the U = U era and Communications with healthcare providers. The women expressed confusion about breastfeeding in the context of undetectable equals untransmittable (U = U). Women of Nordic origin were more unsure about whether breastfeeding was possible in the context of U = U than women of non-Nordic origin. Increased postpartum monitoring with monthly testing of the mother was not seen as a barrier to breastfeeding, but concerns were found regarding infant testing and infant ART exposure. Infant feeding discussions with healthcare providers were welcome but could also question whether breastfeeding was feasible, and many participants highlighted a need for more information.
Healthcare providers caring for women living with HIV must have up-to-date knowledge of HIV transmission risks during breastfeeding and engage in shared decision-making to optimally support infant feeding choices.
高收入国家针对 HIV 感染者的母婴喂养指南最近发生变化，建议采取更具支持性的方法，侧重于共同决策。关于 HIV 感染者的母婴喂养知识以及医疗保健提供者在这种情况下如何与她们进行互动的信息有限。本多中心、纵向、混合方法研究旨在全面细致地了解北欧和非北欧原籍的 HIV 感染者在北欧国家的母婴喂养知识，以及她们在母婴喂养计划方面与医疗保健提供者的互动。
2019-2020 年在丹麦、芬兰和瑞典招募 HIV 感染孕妇。在妊娠晚期（T1）、产后 3 个月（T2）和 6 个月（T3）完成积极的母婴喂养态度问卷（PACIFY）。完成定量调查的女性也被邀请在 T1 和 T3 参加定性半结构式访谈。通过合并调查和访谈结果来评估数据集之间的一致性、互补性、扩展或不协调性，并得出元推断。
共有 44 名 HIV 感染者完成了调查，其中 31 名还参加了访谈。合并分析确定了两个总体领域：U=U 时代的母乳喂养知识和与医疗保健提供者的沟通。女性在无法检测到等于无法传播（U=U）的情况下对母乳喂养感到困惑。北欧原籍的女性比非北欧原籍的女性更不确定在 U=U 的情况下是否可以进行母乳喂养。增加产后每月监测母亲的检测次数并不被视为母乳喂养的障碍，但对婴儿检测和婴儿接受抗逆转录病毒治疗（ART）暴露存在担忧。与医疗保健提供者进行婴儿喂养讨论是受欢迎的，但也可能质疑母乳喂养是否可行，许多参与者强调需要更多信息。
照顾 HIV 感染者的医疗保健提供者必须掌握有关母乳喂养期间 HIV 传播风险的最新知识，并进行共同决策，以最佳支持婴儿喂养选择。
