Opportunities and Constraints to Equitable Implementation of the Revised Infant Feeding Guidelines for Pregnant and Lactating Persons Living With HIV in the United States: A Qualitative Study.

BackgroundThe United States recently expanded infant feeding guidelines for persons living with HIV to include chest/breastfeeding.MethodsA qualitative study was conducted through in-depth interviews with 15 service providers and 7 pregnant/lactating persons living with HIV about infant feeding preferences/experiences and implementation determinants of the revised guidelines. Thematic analysis, guided by the Health Equity Implementation Framework, identified opportunities and constraints to equitable adoption and implementation of the revised infant feeding guidelines for persons living with HIV in the United States.ResultsProviders and persons living with HIV embraced the revised guidelines, citing expanded autonomy in infant feeding choices, destigmatization and normalization of breastfeeding. Nevertheless, overlapping individual (breastfeeding reticence given quantifiable but residual vertical HIV transmission risks), institutional (inconsistent provider/organizational knowledge and resources), and structural (siloed care) implementation barriers were identified.ConclusionsEquitable guideline rollout should consider person-centered counseling, clear communication around risks, and coordinated public sector-led dissemination.