Reproductive health counseling delivered to women living with HIV in the United States

ABSTRACT

Advances in antiretroviral therapy (ART) and reproductive technologies have made transmission of HIV to partners and infants almost completely preventable. Comprehensive reproductive health counseling (CRHC) is an important component of care for women living with HIV, but few women report discussing reproductive health with an HIV care provider. We surveyed a probability sample of U.S. HIV care providers during 2013–2014. Of 2023 eligible providers, 1234 responded (64% adjusted provider response rate). We estimated the percentage delivering CRHC to their female patients. CRHC was defined as delivering each of five components of reproductive health care to most or all female patients. We assessed associations between provider characteristics and delivering CRHC using chi-squared tests and multivariable logistic regression. Of all providers, 49% (95% confidence interval [CI], 42–55) reported delivering all components of CRHC: 71% assessed reproductive intentions of reproductive-aged women, 78% explained perinatal transmission risk, 87% discussed ART for preventing perinatal transmission, 76% provided contraception as appropriate, and 64% provided referrals for preconception care. Among providers who offered primary care (83% of sample), 52% (CI: 44–60) delivered CRHC compared to 33% (CI: 22–44) of providers who did not offer primary care (P = .01). More female providers (46% of sample) compared to male providers delivered CRHC (57% [CI: 48–65] vs. 40% [CI: 31–50], P < .01). Delivery of CRHC by providers did not differ by patient caseload. After adjusting for gender, years of HIV experience, and patient caseload, providing primary care to HIV-infected patients remained associated with delivering CRHC (adjusted prevalence ratio [aPR] 1.48, 95% CI 1.02–2.16). Provider delivery of CRHC is not consistent with current guidelines that recommend discussing reproductive health with all reproductive-aged women who are living with HIV, even among providers offering primary care to their HIV patients.

KEYWORDS:

• HIV
• medical monitoring project
• reproductive health
• women’s health
• provider survey

Acknowledgements

The following are contributions of authors to the study: R.G. contributed to data analysis and wrote the article; H.B. contributed to data analysis and edited the article; J.W. contributed to study conception and edited the article. The authors would like to thank the participating Medical Monitoring Project (MMP) providers, facilities, project areas, and Provider and Community Advisory Board members. They also acknowledge the contributions of the Clinical Outcomes Team, the Behavioral and Clinical Surveillance Branch, and other members of the Division of HIV/AIDS Prevention at CDC and the MMP 2013 Study Group Members: http://www.cdc.gov/hiv/statistics/systems/mmp/resources.html#StudyGroupMembers.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding for the Medical Monitoring Project is provided by the Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.