INFANT FEEDING IN HIV IN CANADA: PROVIDER PERSPECTIVES

Abstract

Infant Feeding in HIV in Canada is an increasingly challenging and confusing aspect of clinical care for providers and patients due to differences in recommendations in Canada compared to low income countries. The frequency of breastfeeding occurring in Canada is not documented or known, and is shrouded in stigma because of fear of criminalization or child apprehension in the midst of a culture where ‘breast is best’ messaging dominates. Breastmilk transmission data comes from observational and randomized controlled trials completed in low resource settings, which may not be generalizable to Canadian clinical settings. Previous literature has not explored provider perspectives on this issue, especially in high resource settings. We developed a survey to explore the knowledge, attitudes and practices of adult and pediatric HIV care providers in Canada. This survey explores the provider knowledge levels, risk tolerance and perceived stigma pertaining to infant feeding in HIV. Using exploratory analysis including descriptive statistics and regression modelling, we developed scales on the above listed three subject areas. The overall opinions of providers were that formula feeding should remain the recommendation due to the potential risk to the infant; and that women should be supported to access formula and resources to overcome barriers to formula feeding. Providers varied in their risk tolerance and the degree of stigma they perceived associated with infant feeding for their patients. Providers did not feel that breastfeeding is a criminal matter, but in some circumstances they would consider involving child protection services. Focus group consultation with women living with HIV, provided insight into the experiences, and clinical and research priorities for women living with HIV on infant feeding. A provider meeting was organized to discuss the challenges and resources pertaining to infant feeding in Canada across the provinces. Providers described diverse patient populations with differing needs. Using a World Café model for discussion, priority needs were decided through consensus including the need for knowledge translational resources to convey information to women living with HIV on infant feeding, and the need for evidence based consensus clinical management guidelines was evident. Quantifying the frequency of breastfeeding occurring in Canada by women living with HIV will help to understand how often this issue is encountered. A preliminary qualitative approach to understanding infant feeding issues for women living with HIV using focus groups is described. However, further exploration in a community based approached is needed to explore the needs and challenges faced by families affected by HIV around infant feeding.