(815) Development of a Decision Aid on Infant Feeding for Birthing People Living with HIV

Objective:
With breastfeeding HIV transmission rates less than 1% for virally suppressed birthing people living with HIV (PLHIV), the United States Department of Health and Human Services now recommends patient-centered counseling for PLHIV on infant feeding options. A prior qualitative study noted several barriers for birthing PLHIV including limited information, lack of regard for preferences, and a scarcity of research and clinical expertise. Thus, there is a need for effective, shared decision-making regarding infant feeding for PLHIV. 

The study objectives were to identify factors influencing infant feeding decisions and to design a patient-facing decision aid for PLHIV.

Study Design:
This qualitative cross-sectional study engaged a multidisciplinary stakeholder team including birthing PLHIV, prenatal clinic staff, and community advocates. During 60–120 minute in-depth semi structured interviews, seven participants shared their experiences with counseling and infant feeding decisions and provided input on a prototype decision aid for infant feeding. We used an inductive thematic analysis approach to generate a codebook and identify, analyze, and report themes in ATLAS.ti. Thematic saturation was achieved.

Results:
Three key themes were identified: (1) how PLHIV interpret the < 1% risk  of HIV transmission varies considerably; (2) infant feeding decisions are shaped by complex, individualized values; and (3) while partners and family, community organizations, and multidisciplinary care teams can significantly impact the decision-making process, PLHIV autonomy must be respected. Stakeholder input was incorporated into a prototype decision aid, which included an interactive values clarification tool with a summary of the participant’s reflections.

Conclusion:
Decision making around infant feeding for birthing PLHIV is a highly personal process that can be significantly impacted by care providers and support people. These results informed the design of a decision aid intended to support shared decision making on infant feeding choices for PLHIV. Next steps are to field test the decision aid.