Providers’ perspectives on preconception counseling and safer conception for HIV-infected women

† Paper presentation: 9th International Conference on HIV Treatment and Prevention Adherence, Miami, 8–10 June 2014.

ABSTRACT

Introduction: Unplanned pregnancy among HIV-infected women can have negative health consequences for women, partners, and neonates. Despite recommendations, preconception counseling (PCC) appears to be infrequently addressed in HIV care. This study explored knowledge, attitudes, and practices among health-care providers regarding PCC, safer conception and pregnancy among HIV-infected women. Methods: Physicians, physician assistants, and nurse practitioners (n = 14) providing obstetric/gynecological and HIV care in urban south Florida public and private hospitals completed structured qualitative interviews. Dominant themes arising included provider perceptions of patient knowledge and practices, provider knowledge and attitudes regarding safer conception, and provider practices regarding reproductive health. Results: Providers perceived patients to have limited reproductive knowledge. Patients’ internalized HIV stigma was a barrier to patient initiation of conception-focused discussions. Provider knowledge and utilization of PCC protocols were limited. PCC barriers included competing medical priorities, failure to address fertility desires, limited knowledge, time limitations, and unclear standard of care. Providers routinely used condom-based HIV prevention as a proxy for addressing reproductive intentions. Discussion: Provider, patient, and structural factors prevented implementation of PCC and provision of information on safer conception; neither were routinely discussed during consultations. Both providers and patients may benefit from interventions to enhance communication on conception.

KEYWORDS:

• Preconception counseling
• HIV
• safer conception methods
• unplanned pregnancy
• qualitative

Acknowledgements

We wish to gratefully acknowledge the contributions of the PATHWAYS team, as well as the health-care providers participating. Drs Jones and Potter developed the study protocol; Drs. Potter, Chakhtoura, Alcaide, and Jones developed interview questions; Ms Coll and Dr Jones coded interviews and developed the manuscript; and all authors provided editorial input on the final manuscript. The SAC had no role in study design or the preparation of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

† Paper presentation: 9th International Conference on HIV Treatment and Prevention Adherence, Miami, 8–10 June 2014.

Additional information

Funding

This study was funded by a grant from the University of Miami Miller School of Medicine's Scientific Advisory Committee [UM SAC #2013-33]. This publication was made possible, in part, by support from the Center for AIDS Research at the University of Miami Miller School of Medicine (NIAID/NIH grant no. P30AI073961). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.